Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US

David J Fei-Zhang^#¹, Camaren M Cuenca^#², Angela D Haskins³, Andrew P Stein⁴, David G Lott⁵, Urjeet A Patel⁴, Stephanie S Smith⁴, Amy L Dimachkieh^{3

6}, Nosayaba Osazuwa-Peters^{7

8

9}, Jill N D'Souza¹⁰, Anthony M Sheyn^{11

12

13}, Jeffrey C Rastatter^{4

14}, Daniel C Chelius^{3

6}

Affiliations

¹ Northwestern University Feinberg School of Medicine, Chicago, IL, USA. david.fei-zhang@northwestern.edu.
² Baylor College of Medicine, Houston, TX, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Division of Laryngology, Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
⁷ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
⁸ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
⁹ Duke Cancer Institute, Duke University, Durham, NC, USA.
¹⁰ Louisiana State University Health Sciences Center Department of Otolaryngology and Division of Pediatric Otolaryngology Children's Hospital of New Orleans, New Orleans, LA, USA.
¹¹ Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, TN, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
¹³ Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, USA.
¹⁴ Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

^# Contributed equally.

PMID: 40374890
PMCID: PMC12304200
DOI: 10.1038/s41416-025-03056-8

Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US

David J Fei-Zhang et al. Br J Cancer. 2025 Aug.

. 2025 Aug;133(2):248-254.

doi: 10.1038/s41416-025-03056-8. Epub 2025 May 15.

Authors

Affiliations

¹ Northwestern University Feinberg School of Medicine, Chicago, IL, USA. david.fei-zhang@northwestern.edu.
² Baylor College of Medicine, Houston, TX, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁵ Division of Laryngology, Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program and Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
⁷ Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA.
⁸ Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
⁹ Duke Cancer Institute, Duke University, Durham, NC, USA.
¹⁰ Louisiana State University Health Sciences Center Department of Otolaryngology and Division of Pediatric Otolaryngology Children's Hospital of New Orleans, New Orleans, LA, USA.
¹¹ Department of Pediatric Otolaryngology, Le Bonheur Children's Hospital, Memphis, TN, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
¹³ Department of Pediatric Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, USA.
¹⁴ Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

^# Contributed equally.

PMID: 40374890
PMCID: PMC12304200
DOI: 10.1038/s41416-025-03056-8

Abstract

Background: Previous social determinants of health (SDoH) studies on laryngeal cancer (LC) have assessed individual factors of socioeconomic status and race/ethnicity but seldom investigate a wider breadth of SDoH-factors for their effects in the real-world. This study aims to delineate how a wider array of SDoH-vulnerabilities interactively associates with LC-disparities.

Methods: This retrospective cohort study assessed 74,495 LC-patients between 1975 and 2017 from the Surveillance-Epidemiology-End Results (SEER) database using the Social Vulnerability Index (SVI) from the CDC, total SDoH-vulnerability from 15 SDoH variables across specific vulnerabilities of socioeconomic status, minority-language status, household composition, and infrastructure/housing and transportation, which were measured across US counties. Univariate linear and logistic regressions were performed on length of care/follow-up and survival, staging, and treatment across SVI scores.

Results: Survival time dropped significantly by 34.37% (from 72.83 to 47.80 months), and surveillance time decreased by 28.09% (from 80.99 to 58.24 months) with increasing overall social vulnerability, alongside advanced staging (OR 1.15; 95%CI 1.13-1.16), increased chemotherapy (OR 1.13; 95%CI 1.11-1.14), decreased surgical resection (OR 0.91; 95%CI 0.90-0.92), and decreased radiotherapy (OR 0.97; 95%CI 0.96-0.99).

Discussion: In this SDoH-study of LCs, detrimental care and prognostic trends were observed with increasing overall SDoH-vulnerability.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The Northwestern University IRB/ethics committee has exempted this study (STU00216871) due to the data queried consisting of publicly available, de-identified data. No consent to participate was necessitated due to the nature of this study comprising retrospective analyses of a publicly available, de-identified national database. Consent to publication: The authors of this manuscript consent to the accuracy of the contents of this manuscript and approve for its submission to be published if accepted.

Figures

**Fig. 1. Relative decreases in months survival with increasing SVI scores.**
Percentage decreases from lowest to highest-SVI quintiles based on mean months survived for total-SVI score and subcomponent SVI-theme subscores.

**Fig. 2. Relative decreases in surveillance months with increasing SVI scores.**
Percentage decreases from lowest to highest-SVI quintiles based on mean surveillance months for total-SVI score and subcomponent SVI-theme subscores.

See this image and copyright information in PMC

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Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US

Affiliations

Assessments of social vulnerability on laryngeal cancer treatment & prognosis in the US

Authors

Affiliations

Abstract

Conflict of interest statement

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