Ethnic and Socioeconomic Disparities in Sinonasal Malignancy: An Analysis of Readmission Rates and Mortality

Background: Sinonasal neoplasms are rare tumors with tremendous histologic variety, and there is a paucity of data regarding ethnic and socioeconomic disparities in outcomes. While disparities in outcomes among different demographics have been well documented in a variety of tumor sites and even in head and neck squamous cell carcinoma (SCC), little is known regarding outcome disparities in sinonasal malignancy, creating a critical gap in the literature. National Cancer Database (NCDB) has robust demographic and outcomes information for patients with sinonasal tumors at over 1500 cancer programs in the United States. We sought to examine ethnic and socioeconomic factors that affected several treatment outcomes in patients with four common sinonasal neoplasms.

Methods: The NCDB was queried for location codes corresponding to the nasal cavity and paranasal sinuses: C30.0, C31.0, C31.1, C31.2, C31.3, C31.8, C31.8. Histology codes included were: 8070 (squamous cell carcinoma), 8072 (melanoma), 8200 (adenoid cystic carcinoma), and 9522 (esthesioneuroblastoma). Only behavior code 3 (Malignant, primary) was included. Patient and center factors were included in univariate analysis against the outcomes of interest: days to discharge, 30-day readmission, 30-day mortality, and 90-day mortality. Those with p < 0.2 and less than 10% missing data were included in a primary multivariate model, that underwent bidirectional stepwise selection to minimize AIC resulting in the final multivariate model.

Results: A review of the database revealed 5898 patients with SCC, 1398 patients with ENB, 960 patients with sinus adenoid cystic carcinoma, and 1310 patients with sinonasal melanoma. African-American race (range 4.5–12.9%) was associated with increased 30-day readmission in sinonasal melanoma (p < 0.05), increased 30-day mortality in sinus adenoid carcinoma and ENB (p < 0.05), and increased 90-day mortality in ENB (p < 0.01). Income also demonstrated a moderate effect on outcomes; patients with income in the lowest quartile had increased surgical stays for sinonasal melanoma (p < 0.01), while patients with top-quartile income and sinonasal SCC having decreased 30-day readmission.

Conclusions: SCC, ENB, adenoid carcinoma, and melanoma represent a large majority of sinonasal tumors, and little robust data exists examining the effect of patient demographic factors on treatment outcomes. Overall, African-American race was correlated with increased hospital readmissions and mortality endpoints in several tumor subtypes. Socioeconomic status also had a modest effect on outcomes, and this data persisted when controlling for tumor and site-specific characteristics. Differences observed in these patient populations most likely have a multifactorial etiology that warrants further research to define specific factors influencing outcomes.