{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:26:47Z","timestamp":1788535607864,"version":"build-2803163510"},"reference-count":20,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n In the modern era, the use of technology can substantially impact care access. Despite the extent of its influence on several chronic medical conditions related to the heart, lungs, and others, the relationship between one\u2019s access to digital resources and oncologic conditions has been seldom investigated in select pathologies among gastrointestinal and head-neck regions. However, studies on the influence of this \u201cdigital inequity\u201d on other cancers pertaining to nasal and paranasal sinus cancer (NPSC) have yet to be performed. This remains in stark contrast to the extent of large data approaches assessing the impact of traditional social determinants\/drivers of health (SDoH), such as factors related to one\u2019s socioeconomic status, minoritized race or ethnicity, and housing-transportation status, on prognostic and treatment outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to use the Digital Inequity Index (DII), a novel, comprehensive tool that quantifies digital resource access on an area- or community-based level, to assess the relationship between inequities in digital accessibility with NPSC disparities in prognosis and care in the United States.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients with NPSC from 2008 to 2017 in the Surveillance, Epidemiology, and End Results Program were assessed for significant regression trends in the long-term follow-up period and treatment receipt across NPSCs with increasing overall digital inequity, as measured by DII. DII was based on 17 census-tract level variables derived from the summarized values overlapping that same time period from the US Census\/American Community Survey and Federal Communications Commission Annual Broadband Report. Variables were categorized as infrastructure-access (ie, electronic device ownership, internet provider availability, and income-broadband subscription ratio) or sociodemographic (education, income, age, and disability), ranked, and then averaged into a composite score to encompass direct and indirect factors related to digital inequity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Across 8012 adult patients with NPSC, males (n=5416, 67.6%) and White race (n=4293, 53.6%) were the most represented demographics. With increasing digital inequity, as measured by increasing total DII scores, significant decreases in the length of long-term follow-up were observed with nasopharyngeal (\n P<\/jats:italic>\n <.01) and maxillary sinus cancers (\n P<\/jats:italic>\n =.02), with decreases as high as 19% (35.2 to 28.5 months, nasopharynx). Electronic device and service availability inequities showcased higher-magnitude contributions to observed associated regression trends, while the income-broadband ratio contributed less. Significantly decreased odds of receiving indicated surgery (lowest odds ratio 0.87, 95% CI 0.80-0.95, maxillary) and radiation (lowest odds ratio 0.78, 95% CI 0.63-0.95, ethmoid) for several NPSCs were also observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Digital inequities are associated with detrimental NPSC care and surveillance trends in the United States, even when accounting for traditional SDoH factors. These results prompt the need to include digital factors into the discussion of contextualizing SDoH-based analyses of cancer care disparities, as well as the specific factors from which prospective implementations and initiatives can invest limited public health resources to alleviate the most pertinent drivers of disparities.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/52627","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T19:21:38Z","timestamp":1752607298000},"page":"e52627-e52627","source":"Crossref","is-referenced-by-count":2,"title":["The Impact of Digital Inequities on Nasal and Paranasal-Sinus Cancer Disparities in the United States: A Cohort Study"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4485-8274","authenticated-orcid":false,"given":"David J","family":"Fei-Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3148-295X","authenticated-orcid":false,"given":"Amelia Sherron","family":"Lawrence","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2378-2522","authenticated-orcid":false,"given":"Daniel C","family":"Chelius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5924-3689","authenticated-orcid":false,"given":"Anthony M","family":"Sheyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0168-549X","authenticated-orcid":false,"given":"Jeffrey C","family":"Rastatter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"issue":"10","key":"R1","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1055\/s-0032-1321867","article-title":"Management and prognosis of patients with squamous cell carcinomas of the nasal cavity and the paranasal sinuses","volume":"91","author":"Pickhard","journal-title":"Laryngorhinootologie"},{"key":"R2","unstructured":"Survival rates for nasal cavity and paranasal sinus cancers. American Cancer Society. URL: https:\/\/www.cancer.org\/cancer\/nasal-cavity-and-paranasal-sinus-cancer\/detection-diagnosis-staging\/survival-rates.html [Accessed 30-03-2023]"},{"key":"R3","unstructured":"The contemporary management of cancers of the sinonasal tract in adults. American Cancer Society. URL: https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.3322\/caac.21752 [Accessed 18-02-2023]"},{"issue":"6","key":"R4","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.anorl.2012.07.007","article-title":"Paranasal sinus cancer","volume":"130","author":"J\u00e9goux","journal-title":"Eur Ann Otorhinolaryngol Head Neck Dis"},{"issue":"6","key":"R5","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1177\/01945998211028161","article-title":"Impact of socioeconomic status on paranasal sinus cancer disease-specific and conditional survival","volume":"166","author":"Sharma","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"5","key":"R6","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1055\/s-0041-1741111","article-title":"Impact of race, ethnicity, and socioeconomic status on nasopharyngeal carcinoma disease-specific and conditional survival","volume":"83","author":"London","journal-title":"J Neurol Surg B Skull Base"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1002\/lio2.698","article-title":"Targets for improving disparate head and neck cancer outcomes in the low-income population","volume":"6","author":"Entezami","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"11","key":"R8","doi-asserted-by":"publisher","first-page":"2421","DOI":"10.1002\/lary.29568","article-title":"Socioeconomic factors affect presentation stage and survival in sinonasal squamous cell carcinoma","volume":"131","author":"Jafari","journal-title":"Laryngoscope"},{"issue":"8","key":"R9","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.2105\/AJPH.2020.305784","article-title":"Broadband internet access is a social determinant of health!","volume":"110","author":"Benda","journal-title":"Am J Public Health"},{"key":"R10","unstructured":"Socioeconomic disparities in patient use of telehealth during the coronavirus disease 2019 surge. JAMA Network. URL: https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2775067 [Accessed 30-03-2023]"},{"key":"R11","unstructured":"Connect2HealthFCC. Federal communications commission. 2015. URL: https:\/\/www.fcc.gov\/about-fcc\/fcc-initiatives\/connect2healthfcc [Accessed 18-03-2023]"},{"key":"R12","unstructured":"Digital divide index. Purdue Center for Regional Development (PCRD). URL: https:\/\/pcrd.purdue.edu\/ruralindianastats\/broadband\/ddi.php?variable=ddi-map&county=Adams [Accessed 18-03-2023]"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/jso.27257","article-title":"The impact of digital inequities on gastrointestinal cancer disparities in the United States","volume":"128","author":"Fei-Zhang","journal-title":"J Surg Oncol"},{"key":"R14","unstructured":"PDQ Adult Treatment Editorial Board. Paranasal sinus and nasal cavity cancer treatment (adult) (PDQ\u00ae): health professional version. In: PDQ Cancer Information Summaries. National Cancer Institute (US); 2002. URL: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK65831 [Accessed 30-03-2023]"},{"issue":"2","key":"R15","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/0196-0709(95)90041-1","article-title":"Prognostic factors in paranasal sinus cancer","volume":"16","author":"Alvarez","journal-title":"Am J Otolaryngol"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1089\/tmj.2018.0328","article-title":"Mobile screening units for the early detection of breast cancer and cardiovascular disease: a pilot telemedicine study in southern Italy","volume":"26","author":"Marino","journal-title":"Telemed J E Health"},{"issue":"6","key":"R17","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1002\/hed.24386","article-title":"Consultation via telemedicine and access to operative care for patients with head and neck cancer in a veterans health administration population","volume":"38","author":"Beswick","journal-title":"Head Neck"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/j.jormas.2020.11.003","article-title":"Digitalized healthcare for head and neck cancer patients","volume":"122","author":"Bouaoud","journal-title":"J Stomatol Oral Maxillofac Surg"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.ijrobp.2016.01.043","article-title":"Radiation therapy noncompliance and clinical outcomes in an urban academic cancer center","volume":"95","author":"Ohri","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"R20","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.0016","article-title":"Assessment of social vulnerability in pediatric head and neck cancer care and prognosis in the United States","volume":"6","author":"Fei-Zhang","journal-title":"JAMA Netw Open"}],"container-title":["JMIR Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e52627","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:37:34Z","timestamp":1782841054000},"score":1,"resource":{"primary":{"URL":"https:\/\/cancer.jmir.org\/2025\/1\/e52627"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,15]]},"references-count":20,"URL":"https:\/\/doi.org\/10.2196\/52627","relation":{},"ISSN":["2369-1999"],"issn-type":[{"value":"2369-1999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,15]]},"article-number":"v11i10e52627"}}