Head and neck cancer in mid-Missouri: demographics, social determinants, and care patterns

Introduction The social determinants of health (SDOH), such as socioeconomic status, rurality, and healthcare access, are increasingly recognized as key factors in the care of head and neck cancer (HNC). In central Missouri, where rurality and socioeconomic disparities are prevalent, understanding these factors is essential for improving early diagnosis and outcomes. Methods Retrospective analysis of 880 patients diagnosed with primary HNC at the Ellis Fischel Cancer Center from 2006 to 2022. Demographic and tumor staging data were collected from electronic medical records. Socioeconomic status was assessed using Area Deprivation Index (ADI) scores, rurality was determined by Rural-Urban Commuting Area (RUCA) codes, and travel distance to care was estimated from patients' addresses. Associations between SDOH factors and stage at diagnosis were evaluated using chi-square tests, ANOVA, and multivariate logistic regression. Results Patients residing more than 100 miles from the cancer center had higher rates of stage IV presentation compared to local Boone County residents (53 vs. 28%; p = 0.005). Higher state ADI scores were significantly associated with advanced-stage disease ( p = 0.017). In multivariate analysis, travel distance (OR = 1.24, 95% CI: 1.09–1.41, p = 0.001) and ADI (OR = 1.06, 95% CI: 1.01–1.11, p = 0.02) remained independently associated with a higher stage at diagnosis. RUCA classification ( p = 0.769) and sex ( p = 0.312) were not significantly associated with stage. Discussion Greater travel distance and higher socioeconomic deprivation were independently associated with advanced-stage HNC at diagnosis. These findings underscore the importance of addressing SDOH HNC care, particularly in rural and disadvantaged populations.