{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T05:48:27Z","timestamp":1771652907173,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"18","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["MOST107\u20102410\u2010H\u2010010\u2010010\u2010MY3"],"award-info":[{"award-number":["MOST107\u20102410\u2010H\u2010010\u2010010\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Late\u2010stage diagnosis of oral cavity cancer (OCC) often results from diagnostic delays due to healthcare access limitations or financial barriers. This study investigates how area\u2010level (\u201cplace\u201d) and individual\u2010level (\u201cpocketbook\u201d) income influence the stage at OCC diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed data on patients diagnosed with OCC between 2010 and 2013 sourced from Taiwan's National Cancer Registry and National Health Insurance databases. The primary outcome was late\u2010stage diagnosis, defined as those initially diagnosed at stage III or IV. Multivariable analyses were conducted to estimate the association between area\u2010level, individual\u2010level, and late\u2010stage diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 16,652 incident OCC patients, with 6639 (39.9%) diagnosed at a late stage and 10,013 (60.1%) at an early stage. Patients with low individual incomes residing in low\u2010income areas had 1.48 times higher odds (95% CI\u2009=\u20091.09 to 2.00,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) of late\u2010stage diagnosis compared to high\u2010income patients in high\u2010income areas. High\u2010income patients; however, in low\u2010income areas had 1.34 times higher odds (95% CI\u2009=\u20091.05 to 1.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) to be diagnosed at a late stage compared to high\u2010income patients in high\u2010income areas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While area\u2010level income plays a significant role in late\u2010stage OCC diagnosis, higher individual income does not fully protect against late\u2010stage diagnosis in low\u2010income areas.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71238","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:33:04Z","timestamp":1757687584000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Place vs. Pocketbook: Associations of Area\u2010Level and Individual\u2010Level Income on Oral Cavity Cancer Late\u2010Stage Diagnosis"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2997-6456","authenticated-orcid":false,"given":"Ethan","family":"Tsai","sequence":"first","affiliation":[{"name":"Tulane University  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brigham","family":"Walker","sequence":"additional","affiliation":[{"name":"Tulane University  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiao\u2010Chi","family":"Wu","sequence":"additional","affiliation":[{"name":"Asia University  Taichung Taiwan"},{"name":"National Yang\u2010Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.6025"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cac2.12009"},{"key":"e_1_2_11_4_1","unstructured":"\u201cMouth and Oral Cancer Statistics\u201d(2022) https:\/\/www.wcrf.org\/cancer\u2010trends\/mouth\u2010and\u2010oral\u2010cancer\u2010statistics\/."},{"key":"e_1_2_11_5_1","unstructured":"\u201cMinistry of Health and Welfare Releases Cancer Incidence Data in 2018\u201d(2023) https:\/\/www.hpa.gov.tw\/EngPages\/Detail.aspx?nodeid=1051&pid=14780."},{"key":"e_1_2_11_6_1","first-page":"1","article-title":"Betel\u2010Quid and Areca\u2010Nut Chewing and Some Areca\u2010Nut Derived Nitrosamines","volume":"85","author":"IARC Working Group on the Evaluation of Carcinogenic Risks to Humans","year":"2004","journal-title":"IARC Monographs on the Evaluation of Carcinogenic Risks to Humans"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0714.1995.tb01132.x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2016.1246572"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200102040-00005"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/147323001003800302"},{"key":"e_1_2_11_11_1","unstructured":"\u201cOral Cancer Clinical Diagnosis and Treatment Guidelines\u201d(2011) National Health Research Institutes Taiwan."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2016.09.017"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2011.04.018"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-316"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3109\/0284186X.2014.998279"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-086588"},{"key":"e_1_2_11_17_1","unstructured":"\u201cCancer Registry Annual Report 2022 Taiwan\u201d(2024) Health Promotion. 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