{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T06:04:39Z","timestamp":1780985079305,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T00:00:00Z","timestamp":1692921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify socioeconomic factors influencing the presentation and outcomes of cutaneous head and neck squamous cell carcinoma (cHNSCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary academic medical center with comprehensive cancer center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients treated for cHNSCC at a single institution between 2008 and 2022 were included. Demographic, socioeconomic data and disease characteristics were obtained from medical record abstraction. Outcome measures included tumor stage, number of distinct primaries, recurrence, and disease\u2010related death. <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> and Mann\u2010Whitney tests were implemented to evaluate clinicopathologic distributions across disease stages. Survival analyses were performed using Cox regression and Kaplan\u2010Meier analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 346 patients met the inclusion criteria. The median age at presentation and length of follow\u2010up was 70.8 and 3.1 years, respectively. The majority of the cohort was white, male, and English\u2010speaking. 13.3% of patients were underinsured and 27.5% were immunosuppressed. Patients who presented with advanced disease were more likely to be underinsured (21.7% vs 9.6%, <jats:italic>P<\/jats:italic>\u2009=\u2009.006) and have a history of homelessness (8.5% vs 2.1%, <jats:italic>P<\/jats:italic>\u2009=\u2009.014). Immunosuppressed patients were more likely to be underinsured (<jats:italic>P<\/jats:italic>\u2009=\u2009.009). Insurance status (1.97 [1.06\u20103.66],\u00a0<jats:italic>P<\/jats:italic>\u2009=\u2009.032) and immune status (2.35 [1.30\u20104.26],\u00a0<jats:italic>P<\/jats:italic>\u2009=\u2009.005) were independently associated with worse recurrence\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Socioeconomic factors that influence access to care, such as insurance status, are associated with cHNSCC disease stage and disease recurrence. These factors may impose barriers that delay diagnosis and treatment. This may result in worse disease\u2010related outcomes and greater treatment\u2010associated morbidity for certain patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.504","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T06:55:36Z","timestamp":1692946536000},"page":"132-140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Insurance Status is Associated With Recurrence in Cutaneous Head and Neck Squamous Cell Carcinoma"],"prefix":"10.1002","volume":"170","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5733-7048","authenticated-orcid":false,"given":"Mitchell T.","family":"Victor","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California, San Diego Health La Jolla California USA"},{"name":"Feinberg School of Medicine Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wynne","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery University of California, San Diego Health La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo J.","family":"Park","sequence":"additional","affiliation":[{"name":"Moores Cancer Center University of California, San Diego Health La Jolla California USA"},{"name":"Division of Hematology and Oncology, Department of Medicine University of California, San Diego Health La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang I. 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