Caryn E Peterson1, Shaveta Khosla2, Gina D Jefferson3, Faith G Davis4, Marian L Fitzgibbon5, Sally Freels2, Timothy P Johnson6, Kent Hoskins7, Charlotte E Joslin8. 1. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States. Electronic address: cpeter1@uic.edu. 2. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States. 3. Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, Chicago, United States. 4. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. 5. University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States; University of Illinois at Chicago, Department of Pediatrics, Chicago, United States. 6. Survey Research Laboratory, Public Administration, University of Illinois at Chicago, 412 South Peoria Street, Chicago, 60607, United States. 7. University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Institute for Health Research and Policy, Chicago, United States; University of Illinois at Chicago, Department of Medicine, Chicago, United States. 8. Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, United States; University of Illinois at Chicago Cancer Center, Cancer Control and Population Science Research Program, Chicago, United States; Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, United States.
Abstract
BACKGROUND: National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013. METHODS: This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression. RESULTS: Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted=1.76, 95% CI 1.49-2.09) than for whites (RRAdjusted=1.12, 95% CI 1.08-1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45-49 years (RRAdjusted=1.57, 95% CI 1.42-1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted=4.32, 95% CI 4.03-4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted. CONCLUSION: In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.
BACKGROUND: National trends show dramatic increases in the incidence of HPV-related head and neck squamous cell carcinomas (HNSCCs) among black and white males. Using cases identified through the National Cancer Data Base, we assessed factors associated with HPV 16- or 16/18 positive HNSCCs among non-Hispanic black and white males diagnosed in the U.S. between 2009 and 2013. METHODS: This sample included 21,524 HNSCCs with known HPV status. Adjusted relative risks (RRs) and 95% confidence intervals (CIs) were estimated using log-binomial regression. RESULTS: Compared to those with HPV-negative tumors, male patients diagnosed with HPV-positive HNSCCs were non-Hispanic white, younger at diagnosis, lived in zip-code areas with higher median household income and higher educational attainment, had private health insurance and no reported comorbidities at diagnosis. Although the risk of HPV-positive HNSCCs increased with measures of higher area-level socioeconomic status, the effect was stronger for non-Hispanic black males (RRAdjusted=1.76, 95% CI 1.49-2.09) than for whites (RRAdjusted=1.12, 95% CI 1.08-1.16). The peak age for diagnosis of HPV-positive HNSCCs occurred in those diagnosed at 45-49 years (RRAdjusted=1.57, 95% CI 1.42-1.73). Oropharyngeal tumors were strongly associated with HPV-positivity (RRAdjusted=4.32, 95% CI 4.03-4.63). In the analysis restricted to oropharyngeal anatomic sites, similar patterns persisted. CONCLUSION: In our analysis, measures of economic advantage were associated with an increased risk of HPV-positive HNSCCs. In order to develop effective interventions, greater understanding of the risk factors for HPV-positive HNSCCs is needed among both high-risk males and their healthcare providers.
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