TY - JOUR
T1 - The impact of digital inequities on laryngeal cancer disparities in the US
AU - Edwards, Evan R.
AU - Fei-Zhang, David J.
AU - Stein, Andrew P.
AU - Lott, David G.
AU - Chelius, Daniel C.
AU - Sheyn, Anthony
AU - Rastatter, Jeffrey
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Objectives: To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. Methods: DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. Results: With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03–1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04–1.08), and radiation therapy (OR 1.02; 95 % CI 1.00–1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94–97). Conclusions: Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.
AB - Objectives: To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. Methods: DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. Results: With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03–1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04–1.08), and radiation therapy (OR 1.02; 95 % CI 1.00–1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94–97). Conclusions: Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.
KW - Broadband service
KW - Internet access
KW - Laryngeal cancer
KW - Social determinants of health
KW - Technology infrastructure
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U2 - 10.1016/j.amjoto.2023.104066
DO - 10.1016/j.amjoto.2023.104066
M3 - Article
C2 - 37820390
AN - SCOPUS:85173215085
SN - 0196-0709
VL - 45
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 1
M1 - 104066
ER -