# The Impact of Digital Inequities on Oropharyngeal Cancer Disparities in the United States

## TL;DR

Digital inequities in the U.S. are linked to worse outcomes for oropharyngeal cancer patients, including shorter survival and less effective treatment.

## Contribution

This study is the first to link digital inequity with oropharyngeal cancer disparities using a comprehensive index and large patient data.

## Key findings

- Higher digital inequity is associated with shorter follow-up and survival times for OPC patients.
- Internet affordability has the largest impact on digital inequity-related disparities in OPC care.
- Patients with high digital inequity are less likely to receive recommended cancer treatments.

## Abstract

To assess associations of digital inequity with oropharyngeal cancer (OPC) prognostic and care outcomes in the United States while adjusting for traditional social determinants/drivers of health (SDoH).

Retrospective cohort study.

United States.

In total, 70,604 patients from 2008 to 2017 were assessed for regression trends in long‐term follow‐up period, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the Digital Inequity Index (DII). DII is based on 17 census‐tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure‐access (ie, digital‐related variables) or sociodemographic (ie, education, income, and disability status) and weighted‐averaged into a composite score.

With increasing DII, decreases in length of follow‐up (10.22%, 32.9‐29.5 months; P < .001) and survival (8.93%, 19‐17.3 months; P < .001) were observed. Affordability of internet access displayed the largest influence, followed by device access and internet‐service availability. Compared to OPC patients with low digital inequity, high digital inequity was associated with increased odds of diagnosing more than one malignant tumor (odds ratio [OR] 1.01, 95% CI 1.01‐1.03; P = .012) and advanced staging (OR 1.01, 95% CI 1.00‐1.02; P = .034), while having decreased odds of receiving indicated chemotherapy (OR 0.98, 95% CI 0.97‐0.99; P < .001), radiation therapy (OR 0.98, 95% CI 0.97‐0.99; P < .001), or primary surgery (OR 0.98, 95% CI 0.97‐0.99; P < .001).

Digital inequities contribute to detrimental trends in OPC patient care and prognosis in the United States. These findings can inform strategic discourse targeted against the most pertinent disparities in the modern‐day environment.