Disparities in sinonasal squamous cell carcinoma short- and long-term outcomes: Analysis from the national cancer database.

To examine sociodemographic, hospital-specific, and disease-related characteristics in relation to outcomes in sinonasal squamous cell carcinoma (SCC). The National Cancer Database was queried for location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy. Multivariate analyses were performed against short- and long-term outcomes (overall survival, days to discharge, 30-day readmission, and 30- and 90-day mortality). The database included 5,584 sinonasal SCC patients with an overall median survival of 53.5 months (95% confidence interval [CI]: 49.7-57.8). On multivariate analysis, uninsured, Medicaid, and Medicare were independently associated with worse overall survival compared to private insurance (hazard ratio [HR]: 1.49, 95% CI: 1.22-1.82, P < .001; HR: 1.57, 95% CI: 1.34-1.85, P < .001; and HR: 1.14, 95% CI: 1.01-1.29, P = .03, respectively). Both Medicaid and Medicare were also associated with increased 30-day mortality (HR: 1.36, 95% CI: 1.76-143.29, P = .02; HR: 8.27, 95% CI: 1.66-70.88, P = .02, respectively), and Medicaid patients spent more time in the hospital following surgery (difference in days to discharge: HR: 2.09, 95% CI: 0.57-3.61, P < .01). Compared to white race, other race was associated with improved overall survival (HR: 0.79, 95% CI: 0.63-0.99, P = .04) but increased 30-day readmissions (HR: 3.85, 95% CI: 1.58-8.38, P < .01). Hispanic ethnicity was associated with increased 30-day readmissions (HR: 2.35, 95% CI: 1.08-4.75, P = .02]. The highest income bracket (≥$63,000) was associated with fewer hospital readmissions (HR: 0.33, 95% CI: 0.13-0.79, P = .01). Sociodemographic and economic differences in outcomes of patients with sinonasal SCC cancer exist. An understanding of these differences may help minimize disparities in oncologic treatment. 2c. Laryngoscope, 128:560-567, 2018.

Carey RM ，Parasher AK ，Workman AD ，Yan CH ，Glicksman JT ，Chen J ，Palmer JN ，Adappa ND ，Newman JG ，Brant JA ... -  《-》

Socioeconomic Factors Affect Presentation Stage and Survival in Sinonasal Squamous Cell Carcinoma.

Socioeconomic factors affect oncologic outcome in sinonasal squamous cell carcinoma (SNSCC). However, the relationship between these factors and stage at presentation (SAP)-a critical, early point in the care cycle-is not known. This study sought to determine the role of race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors in SAP and survival among patients with advanced SNSCC. Retrospective cohort study. Using the National Cancer Database, 6,155 patients with SNSCC were identified and divided into those with "early" (Stage I or II; 2,212 (35.9%)) versus "advanced" (Stage III or IV; 3,943 (64.1%)) disease. Associations between sociodemographic and socioeconomic factors on SAP and survival were analyzed using multivariable logistic regression and Cox proportional hazard models. Black (odds ratio [OR]: 2.18, CI: 1.74-2.76), Asian and Pacific Islander (API) (OR: 2.37, CI: 1.43-4.14), and Medicaid or uninsured (OR: 2.04, CI: 1.66-2.53) patients were more likely to present with advanced disease. Among patients with advanced disease, API patients demonstrated the highest 10-year survival rate (30.2%), and Black patients had the lowest 2-, 5-, and 10-year survival rates (47.7%, 31.9% and 19.2%, respectively). Older age (HR:1.03, CI:1.03-1.04), Black race (HR:1.39, CI:1.21-1.59), Medicaid or uninsured status (HR:1.48, CI:1.27-1.71), and treatment at a community hospital (HR:1.25, CI:1.14-1.37) were associated with poorer overall survival among patients with advanced disease. Factors including race/ethnicity, treatment facility type, insurance status/carrier, and other socioeconomic factors influence SAP and survival in SNSCC. An improved understanding of how these factors relate to outcomes may elucidate opportunities to address gaps in education and access to care in vulnerable populations. 4 Laryngoscope, 131:2421-2428, 2021.

Jafari A ，Shen SA ，Qualliotine JR ，Lehmann AE ，Humphreys IM ，Abuzeid WM ，Bergmark RW ，Gray ST ... -  《-》

Coronary artery bypass graft readmission rates and risk factors - A retrospective cohort study.

Hospital readmissions contribute substantially to the overall healthcare cost. Coronary artery bypass graft (CABG) is of particular interest due to its relatively high short-term readmission rates and mean hospital charges. A retrospective review was performed on 2007-2011 data from California, Florida, and New York from the State Inpatient Databases, Healthcare Cost and Utilization Project. All patients ≥18 years of age who underwent isolated CABG and met inclusion/exclusion criteria were included. Insurance status was categorized by Medicaid, Medicare, Private Insurance, Uninsured, and Other. Primary outcomes were unadjusted rates and adjusted odds of readmission at 30- and 90-days. Secondary outcomes included diagnosis at readmission. A total of 177,229 were included in the analyses after assessing for exclusion criteria. Overall 30-day readmission rate was 16.1%; rates were highest within Medicare (18.4%) and Medicaid (20.2%) groups and lowest in the private insurance group (11.7%; p < 0.0001). Similarly, 90-day rates were highest in Medicare (27.3%) and Medicaid (29.8%) groups and lowest in the private insurance group (17.6%), with an overall 90-day rate of 24.0% (p < 0.0001). The most common 30-day readmission diagnoses were atrial fibrillation (26.7%), pleural effusion (22.5%), and wound infection (17.7%). Medicare patients had the highest proportion of readmissions with atrial fibrillation (31.7%) and pleural effusions (23.3%), while Medicaid patients had the highest proportion of readmissions with wound infections (21.8%). Similar results were found at 90 days. Risk factors for readmission included non-private insurance, age, female sex, non-white race, low median household income, non-routine discharge, length of stay, and certain comorbidities and complications. CABG readmission rates remain high and are associated with insurance status and racial and socioeconomic markers. Further investigation is necessary to better delineate the underlying factors that relate racial and socioeconomic disparities to CABG readmissions. Understanding these factors will be key to improving healthcare outcomes and expenditure.

Feng TR ，White RS ，Gaber-Baylis LK ，Turnbull ZA ，Rong LQ ... -  《-》

Education and insurance status: Impact on treatment and survival of sinonasal cancer patients.

To understand the impact of education and insurance as social determinants of health on sinonasal cancer treatment and outcomes. Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Demographics, tumor characteristics, location, stage at diagnosis, treatment, and survival data for 1,365 patients diagnosed with sinonasal cancers were extracted from the SEER database. All statistical analyses were performed using SAS 9.5. The Fine and Grey method was used to assess covariate impacts. Medicaid patients were more likely to live in counties with lower educational levels (8.32% vs. 6.46% below ninth grade education, P < .0001) and lower median household incomes ($56,316 vs. $60,284, P = .0004). Medicaid patients presented with later (T3-T4) stage disease compared to other insurances (P = .0007) and larger tumor size (P = .011). Medicaid patients were less likely to have surgery recommended (P = .0017) or receive surgery as part of their treatment (P = .0033). Analysis of histology-specific 5-year survival rates were lower for Medicaid patients with squamous cell carcinoma (SCCA) (P = .016). This is the first and largest study to examine how education and insurance status may impact treatment and outcomes in sinonasal cancers. It is the first using this method of examining other covariates and informing associated risk. Patients with Medicaid and less education present with larger sinonasal cancers. They are less likely to have surgery recommended or receive surgery. For SCCA, the most common histology, Medicaid patients have significantly worse survival. Further emphasis on education and improving health literacy is needed in the at-risk Medicaid populations. NA Laryngoscope, 130:649-658, 2020.

Agarwal P ，Jones EA ，Devaiah AK 《-》

Sinonasal Squamous Cell Carcinoma Outcomes: Does Treatment at a High-Volume Center Confer Survival Benefit?

Teitelbaum JI ，Issa K ，Barak IR ，Ackall FY ，Jung SH ，Jang DW ，Abi Hachem R ... -  《-》