{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:48:12Z","timestamp":1786470492393,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000892","name":"Prostate Cancer Foundation","doi-asserted-by":"publisher","award":["Young Investigator Award"],"award-info":[{"award-number":["Young Investigator Award"]}],"id":[{"id":"10.13039\/100000892","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Head and neck cancer (HNC) remains a major global cause of cancer morbidity and mortality, with disproportionately poor outcomes in low\u2010 and middle\u2010income countries. Substantial cross\u2010national disparities suggest an important role for health system strengthening. We evaluated associations between national health system characteristics and global HNC outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a cross\u2010sectional ecological analysis of 185 countries using sex\u2010stratified, age\u2010standardized incidence and mortality estimates from the International Agency for Research on Cancer (IARC) GLOBOCAN 2022 database. The primary outcome was the composite mortality\u2010to\u2010incidence ratio (MIR) for aggregated HNCs, including cancers of the lip and oral cavity, oropharynx, larynx, nasopharynx, hypopharynx, and salivary gland. Eleven national health system indicators capturing health financing, workforce density, service availability, socioeconomic development, and gender equity were evaluated. Univariable linear regressions identified candidate variables using Bonferroni correction (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0045), followed by multivariable modeling with assessment for multicollinearity using variance inflation factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 11 health system indicators were significantly associated with HNC MIR on univariable analysis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for all). In multivariable analysis of 123 countries with complete data, higher Universal Health Coverage (UHC) service coverage index and higher gross domestic product (GDP) per capita were independently associated with lower (improved) HNC MIR (model\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.70). Findings were consistent in sex\u2010stratified analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Across countries, progress toward universal health coverage and greater national economic capacity was independently associated with improved HNC outcomes. These findings may help to inform efforts at the level of health systems to improve HNC outcomes worldwide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>N\/A.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70534","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T03:55:48Z","timestamp":1775534148000},"page":"3797-3802","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Health Systems Analysis of Global Head and Neck Cancer Outcomes"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6119-0889","authenticated-orcid":false,"given":"Edward Christopher","family":"Dee","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian E.","family":"Go","sequence":"additional","affiliation":[{"name":"Cebu Institute of Medicine  Cebu City Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin Jay Garbes","family":"Feliciano","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYC+HHC\/Elmhurst Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-6173","authenticated-orcid":false,"given":"James Fan","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Willmann","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Hospital Zurich University of Zurich  Zurich Switzerland"},{"name":"Department of Medical Physics Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Lapen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teeradon","family":"Treechairusame","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milit S.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"},{"name":"Department of Molecular Biosciences The University of Texas at Austin  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sruthi","family":"Ranganathan","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Cambridge  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Hammond","sequence":"additional","affiliation":[{"name":"Department of Biology Harvard University  Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingzhi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7066-4492","authenticated-orcid":false,"given":"Annu","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Surgery Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Wong","sequence":"additional","affiliation":[{"name":"College of Public Health National Taiwan University  Taipei Taiwan"},{"name":"Department of Molecular, Cellular, and Developmental Biology Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa E.","family":"Jacomina","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Benavides Cancer Institute University of Santo Tomas Hospital  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneeth","family":"Iyengar","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Memorial 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