Socioeconomic status, XXXX , and overall survival in head and neck squamous cell carcinomas in Toronto, Canada.

@entity1 @entity135 @entity986 @entity5 @entity1082 @entity285 @entity159
BACKGROUND: Despite universal healthcare in some countries, lower @entity159 ( @entity159 ) has been associated with worse @entity5 survival. The influence of @entity159 on @entity135 ( @entity135 ) survival is of immense interest, since @entity159 is associated with the risk and prognostic factors associated with this disease. @entity1 AND METHODS: Newly diagnosed @entity135 @entity1 from 2003 to 2010 (n=2124) were identified at Toronto's Princess Margaret Cancer Centre. Principal component analysis was used to calculate a composite score using neighbourhood-level @entity159 variables obtained from the 2006 Canada Census. Associations of @entity159 with overall survival were evaluated in @entity135 subsets and by @entity986 status (surrogate for @entity1082 ). RESULTS: @entity159 score was higher for oral cavity (n=423) and @entity986 -positive @entity5 ( @entity5 , n=404) @entity1 compared with other disease sites. Lower @entity159 was associated with worse survival [HR 1.14 (1.06-1.22), p=0.0002], larger @entity5 staging (p<0.001), current smoking (p<0.0001), heavier @entity285 consumption (p<0.0001), and greater comorbidity (p<0.0002), but not with treatment regimen (p>0.20). After adjusting for age, sex, and stage, the lowest @entity159 quintile was associated with the worst survival only for @entity5 @entity1 [HR 1.66 (1.09-2.53), n=832], primarily in the @entity986 -negative subset [HR 1.63 (0.96-2.79)]. The predictive ability of the prognostic models improved when smoking/ @entity285 was added to the model (c-index 0.71 vs. 0.69), but addition of @entity159 did not (c-index 0.69). CONCLUSION: @entity159 was associated with survival, but this effect was lost after accounting for other factors (age, sex, TNM stage, smoking/ @entity285 ). Lower @entity159 was associated with greater smoking, @entity285 consumption, comorbidity, and stage.
