Original Research Does Socioeconomic Status Affect Stage at Presentation for Larynx Cancer in Canada’s Universal Health Care System? Otolaryngology– Head and Neck Surgery 1–6 Ó American Academy of Otolaryngology–Head and Neck Surgery Foundation 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0194599818798626 http://otojournal.org Diana Khalil, MD, FRCSC 1 , Martin J. Corsten, MD, FRCSC 2 , Margaret Holland 3 , Adele Balram 3 , James Ted McDonald, PhD 4 , and Stephanie Johnson-Obaseki, MD, FRCSC 1 No sponsorships or competing interests have been disclosed for this article. Abstract Objective. Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investi- gated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita). Study Design. Registry-based multicenter cohort analysis. Setting. This was a national study across Canada, a country with a single-payer, universal health care system. Subjects. All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR). Methods. Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation. Results. A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P \ .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P \.005). Conclusion. There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian uni- versal health care system. Keywords laryngeal cancer, stage at diagnosis, socioeconomic status, rural residence, urban residence, income, age at diagnosis Received October 18, 2017; revised March 1, 2018; accepted August 14, 2018. Background In 2013, there were an estimated 89,081 people living with laryngeal cancer in the United States. In 2016, there were an approximately 13,340 new cases in the United States and 3620 deaths from laryngeal cancer. 1 These numbers are comparable per population with an estimated 1050 new cases and 400 deaths in Canada in 2016. 2 Most people with laryngeal cancer present with hoarseness at an early stage in their disease. 3 Early diagnosis of laryngeal cancer is depen- dent on patient and physician awareness that persistent hoar- seness needs to be investigated as well as access to an otolaryngologist. Despite the early symptom of hoarseness, only 55.3% of laryngeal cancers are diagnosed at the local stage. Late diagnosis at more advanced stages has a direct effect on prognosis as the 5-year survival of localized laryn- geal cancer is 76.3%, compared to 44.5% and 35.1% with regional and distant disease, respectively. 1 Many cancers have a worsened survival in patients with lower socioeconomic status (SES). 4 SES is a function of income, education, and occupation and is thought to be a marker of underlying physical and social factors that cause cancer and reduced survival. 5 Such factors include stage at presentation, education, access to health care services, diet, environmental exposure, and differential levels of tobacco and alcohol consumption. 6 There is an increasing debate regarding the ability to provide adequate health care access in the public system to citizens across varied SES classes. 1 Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada 2 Department of Otolaryngology–Head and Neck Surgery, Methodist Dallas Medical Center, Dallas, Texas, USA 3 New Brunswick Institute for Research, Data, and Training, University of New Brunswick, Fredericton, NB, Canada 4 Department of Economics, University of New Brunswick, Fredericton, NB, Canada This article was presented at the 2017 AAO-HNSF Annual Meeting and OTO Experience; September 10-13, 2017; Chicago, Illinois. Corresponding Author: Diana Khalil, MD, FRCSC, Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, S3–501 Smyth Road, Ottawa, ON KIH 8L6, Canada. Email: diana.khalil@medportal.ca