Language
English
Publication Date
7-1-2026
Journal
Cancer Causes & Control
DOI
10.1007/s10552-026-02209-1
PMID
42384290
PMCID
PMC13323222
PubMedCentral® Posted Date
7-1-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Purpose: Racial and ethnic differences in oral cavity cancer (OCC) stage at diagnosis are substantial, but the reasons remain unclear. We assessed insurance status and social neighborhood factors as potential pathways.
Methods: Using the Texas Cancer Registry, we identified adults diagnosed with OCC between 2010 and 2020. We examined the crude and multivariable associations of race and ethnicity, insurance status, and social neighborhood factors with stage at diagnosis. We investigated the mediating effects of insurance status and neighborhood-level social factors on racial and ethnic differences in stage at diagnosis using four-way decomposition with modified Poisson regression and robust standard errors.
Results: Among the 6,488 patients, 49.6% were diagnosed at a late stage. Compared to non-Hispanic White patients, non-Hispanic Black, Hispanic, and non-Hispanic Asian Americans, Native Hawaiians, and Pacific Islanders had 51% (Prevalence Ratio [PR]: 1.51; 95% confidence interval [95% CI]: 1.40, 1.63), 29% (PR: 1.29; 95% CI 1.22-1.37), and 17% (PR: 1.17; 95% CI 1.05-1.32) higher risks of being diagnosed at a late stage, respectively. For non-Hispanic Black patients, being uninsured, living in a vulnerable neighborhood, and living in a deprived neighborhood explained roughly 20%, 31%, and 15% of the disparity in late stage diagnosis, respectively. These pathways accounted for similar proportions of the disparity in stage at diagnosis among Hispanic patients.
Conclusions: Insurance status and neighborhood-level social factors may partially account for the differences in OCC stage at diagnosis between racial and ethnic groups. Identifying these pathways may help clarify and reduce these disparities.
Keywords
Adult, Aged, Female, Humans, Male, Middle Aged, Ethnicity, Healthcare Disparities, Mouth Neoplasms, Neighborhood Characteristics, Neoplasm Staging, Registries, Social Determinants of Health, Socioeconomic Disparities in Health, Texas, Racial Groups, Oral cavity cancer, Stage at diagnosis, Racial and ethnic disparities, Mediation analysis of social factors, Health insurance
Published Open-Access
yes
Recommended Citation
Tortolero, Guillermo A; Sturgis, Erich M; Sokale, Itunu O; et al., "Social Determinants As Pathways in Disparities in Oral Cavity Cancer Stage at Diagnosis: A Registry-Based Analysis From 2010–2020" (2026). Faculty, Staff and Students Publications. 7437.
https://digitalcommons.library.tmc.edu/baylor_docs/7437