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Racial and Socioeconomic Disparities in Ocular Surface Squamous Neoplasia: A National Cancer Database Analysis

Kevin YZ, Sarah A, Peter S

Objective: A retrospective population-based study to investigate racial and socioeconomic disparities in patients diagnosed with ocular surface squamous neoplasia (OSSN).

Methods: Non-Hispanic white (NHW) and African American (AA) patients with OSSN with known age, insurance, gender, and zip code-level income and education were selected from the National Cancer Database. Patients were stratified based on race into two mutually exclusive groups, and unadjusted comparisons were made with the chisquareor Mann-Whitney tests. Survival was examined with the Kaplan-Meier method and a Cox regression model.

Results: Of the 2,402 identified patients from 2004 to 2015, 117 were African American. Unadjusted differences were found between groups in regard to age, histology, insurance, income, and education. African American patients in comparison to NHW patients were younger (mean age: 62 years vs. 70 years; p<0.001), represented a higher proportion of Medicaid use (10.3% vs. 3.2%) or uninsured (10.3% vs. 2.7%), and resided in areas with low educational attainment (32.5% vs. 16.1% of NHW). Multivariate analysis found higher risk of death for older African American males with no private insurance, and for those from areas of lowest level of income.

Conclusion: Disparities in socioeconomic factors were observed in African American patients with OSSN. Overall, OSSN occurs at a younger age in African Americans, who also are socioeconomically disadvantaged and face poorer prognoses. This association between social inequality and poor outcome warrant further investigation.