Geographic and Socioeconomic Landscape of Veterans With Head and Neck Cancer

Abstract

Background: US Veterans experience higher rates and worse outcomes for head and neck squamous cell carcinoma (HNSCC) compared to civilians. Geographic and socioeconomic barriers remain unclear. Methods: This retrospective descriptive study analyzed VA data nationwide (2012–2022), identifying Veterans with HNSCC using ICD codes. Subsites included oral cavity, oropharynx (OPC), hypopharynx, larynx, and nasopharynx. Rurality, deprivation, and travel distances were assessed. Results: Among 75,453 Veterans with HNSCC, 36% lived in rural areas, with travel times of 94 min to tertiary VA facilities. Approximately 32% had high deprivation (area deprivation indices [ADI] ≥ 75). OPC cases increased from 26.3% in 2012 to 46% in 2022, while laryngeal cancers declined. OPC patients were less deprived (p < 0.001) but had similar travel distances and rurality compared to non-OPC patients. Conclusion: Overall, Veterans experience high deprivation, long travel times, and over one-third live in rural communities, highlighting potential barriers to access and equity among Veterans with HNSCC.