Neighborhood-Level Social Vulnerability, Race and Ethnicity, and Stage at Diagnosis: A Population-Based Study of 12,957 Patients with Oral Cavity Cancer

Background: Oral cavity cancer (OCC) is marked by racial and ethnic disparities. We examined these differences in OCC stage at diagnosis and whether neighborhood-level social vulnerability, a measure of susceptibility to hardship at the census-tract level, modifies disparities. Methods: We identified adults newly diagnosed with OCC (1995 to 2020) from the Texas Cancer Registry. We estimated the association between stage at diagnosis and race and ethnicity using logistic regression and assessed effect modification by neighborhood-level social vulnerability. Results: The sample included 12,957 reported OCC cases, 77% non-Hispanic White, 6% non-Hispanic Black, and 14% Hispanic patients, and 47.4% late stage at diagnosis. Non-Hispanic Black (OR 3.30; 95% CI 2.81, 3.88), Hispanic (OR 2.02; 95% CI 1.83, 2.24), non-Hispanic Asian Americans, Native Hawaiians, and Pacific Islanders (OR 1.66; 95% CI 1.33, 2.07) patients had higher odds of late stage at diagnosis compared to non-Hispanic White counterparts. Neighborhood-level social vulnerability modified the associations on an additive scale only for non-Hispanic Black patients. Non-Hispanic Black patients living in the most (OR 4.72; 95% CI 3.70, 6.02) but not least (OR 1.55; 95% CI 0.81, 2.94) vulnerable neighborhoods had higher odds of late stage at diagnosis compared to non-Hispanic White patients living in the least vulnerable neighborhoods. Conclusions: Racial and ethnic minorities were diagnosed with later stage OCC and minority patients living in the most vulnerable neighborhoods had the highest odds. Addressing neighborhood-level social factors may lessen disparities. Impact: Understanding the underlying mechanisms driving these disparities is essential to developing effective interventions to mitigate them.