Explaining the effects of socio-economic deprivation on survival in a national prospective cohort study of 1909 patients with head and neck cancers

Background: Socio-economic differences in survival from head and neck cancers are among the largest of any malignancies. Population-based data have been unable to explain these differences. Aims: To describe survival from head and neck cancers in a large cohort of patients for whom a range of socio-economic, demographic, behavioural and casemix data was available. Methods: Prospective cohort study using data from the Scottish Head and Neck Audit on all patients diagnosed with a head and neck cancer in Scotland between 1st September 1999 and 31st August 2001 linked to General Register Office for Scotland death records to 30th June 2006. Cox proportional hazards models were produced to describe adjusted hazards of death according to socio-economic circumstances, using validated area-based DEPCAT scores. Results: Data on 1909 patients were analysed. 71.0% were male and mean age was 64.3 (SD 12.2) years. Overall 5-year survival was 45.6% (95% CI: 43.4–47.8%). In order of strength of association in univariate regression, World Health Organisation Performance Status, disease stage, patient age, tumour site, smoking status, alcohol use, tumour differentiation, and deprivation were significant predictors of all-cause mortality but after multiple adjustment, deprivation was no longer an independent predictor of survival. Conclusions: Socio-economic differentials in survival from head and neck cancers are determined by a mixture of risk factors, some of which may be amenable to targeted earlier detection methods and lifestyle interventions. However, further research is needed to understand the impacts of performance status in more deprived patients.