The Impact of Digital Inequities on Nasal and Paranasal Sinus Cancer Disparities in the United States: A Cohort Study
ABSTRACT
Background:
In the modern era, the use of technology can substantially impact care access. However, the association of “digital inequities” with nasal and paranasal-sinus cancer (NPSC) outcomes remains seldom-studied.
Objective:
To utilize the Digital Inequity Index (DII), a novel, comprehensive tool that quantifies digital resource access, to assess its impact on NPSC disparities in the US.
Methods:
8,012 NPSC patients from 2008-2017 in SEER were assessed for significant regression trends in 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 US Census and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e. electronic device ownership, internet provider availability, income-broadband subscription ratio) or sociodemographic (education, income, age, disability), ranked, and then averaged into a composite score.
Results:
With increasing digital inequity, significant decreases in length of long-term follow-up were observed with nasopharyngeal (p<0.001) and maxillary sinus cancers (p=0.022), 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 income-broadband ratio contributed less. Significantly decreased odds of receiving indicated surgery and radiation for several NPSCs were also observed.
Conclusions:
Digital inequities contribute to detrimental NPSC-care trends in the US. This should prompt discussion of strategies to alleviate disparities while contextualizing national sociodemographics of online access. Clinical Trial: N/A
Citation
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Copyright
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