Measures of economic advantage associated with HPV-positive head and neck cancers among non-Hispanic black and white males identified through the National Cancer Database

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. (C) 2017 Elsevier Ltd. All rights reserved.