Original Research Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States Otolaryngology– Head and Neck Surgery 1–7 Ó American Academy of Otolaryngology–Head and Neck Surgery Foundation 2019 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599819856305 http://otojournal.org Nicole L. Lebo, MD 1 , Diana Khalil, MD 1 , Adele Balram, MPH 2 , Margaret Holland, MA 2 , Martin Corsten, MD 3 , James Ted McDonald, PhD 4 , and Stephanie Johnson-Obaseki, MD, MPH 1 Sponsorships or competing interests that may be relevant to content are dis- closed at the end of this article. Abstract Objective. Identify socioeconomic predictors of stage at diag- nosis of laryngeal cancer in the United States. Study Design. Retrospective analysis of the North American Association of Central Cancer Registries’ Incidence Data–Cancers in North America Deluxe Analytic File for expanded races. Setting. All centers reporting to the US Centers for Disease Control and Prevention’s National Program of Cancer Registries. Subjects and Methods. All cases of laryngeal cancer in adult patients from 2005 to 2013 were reviewed. Ordinal logistic regression models were used to evaluate odd ratios (ORs) for socioeconomic indicators potentially predictive of advan- cing American Joint Committee on Cancer stage at diagnosis. Results. A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P \ .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P \ .001; 95% CI, 0.536- 0.609). Once adjusted for regional price and wage dispari- ties, relative income was not a significant predictor of stage at presentation across multiple analyses. Conclusion. Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence. Keywords laryngeal cancer, stage at diagnosis, socioeconomic status, insurance status, income Received January 7, 2019; revised April 25, 2019; accepted May 21, 2019. L aryngeal cancer accounts for 0.8% of new cancer cases in the United States each year, with an esti- mated 13,150 new cases and 3710 deaths expected for 2018. 1 A number of studies have demonstrated dimin- ished survival in patients with lower socioeconomic status (SES), both for laryngeal cancer specifically and for head and neck cancers as a whole. 2-5 In 2004, Coleman et al examined survival for laryngeal cancer in England and Wales and found that 5-year survival was 17% lower (95% CI, 12%-22%) among men in the most deprived group as compared with those in the most affluent group. 6 This was 1 Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada 2 New Brunswick Institute for Research, Data, and Training, Fredericton, New Brunswick, Canada 3 Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada 4 Department of Economics, University of New Brunswick, Fredericton, New Brunswick, Canada The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorse- ment by the Maritime SPOR Support Unit of the named funding partners is intended or should be inferred. The data used in this article are based on the North American Association of Central Cancer Registries December 2015 data submission. Support for cancer registries is provided by the state, province, or territory in which the registry is located. In the United States, registries also participate in the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program or the Centers for Disease Control and Prevention’s National Program of Cancer Registries or both. In Canada, all registries submit data to the Canadian Cancer Registry, maintained by Statistics Canada. Corresponding Author: Martin Corsten, MD, Division of Otolaryngology–Head and Neck Surgery, Dalhousie University, Room 3037, Third Floor, Dickson Building, Victoria General Site, 5820 University Avenue, Halifax, Nova Scotia B3H 1V7, Canada. Email: mjcorsten@gmail.com