Nativity status and oral cancer survival in the United States: Implications for dental clinical practice

Objective: Nativity status is a major determinant of health and healthcare access in the United States. This study compared oral squamous cell carcinoma (OSCC) survival between US-born and foreign-born patients. Method and Materials: Data were obtained from the 1988-2008 Surveillance, Epidemiology and End Results database. A Cox proportional hazards multivariate model was used to assess the eff ect of birthplace on OSCC survival, adjusting for other sociodemographic and clinical covariates. Results: US-born patients had a higher median survival time (19.3 years; 95% confi dence interval [CI]: 18.6-19.7) compared to foreign-born patients (10.7 years; 95% CI: 10.1-11.3). After adjusting for other factors, being born in the US conferred a modest protective eff ect from OSCC mortality (hazard ratio [HR] = 0.93, 95% CI: 0.87- 0.99). Other factors that conferred better survival included involvement of paired structures (HR = 0.65; 95% CI: 0.58- 0.74), lip involvement rather than tongue lesions (HR = 0.76; 95% CI: 0.71-0.82), and receipt of either surgery (HR = 0.89; 95% CI: 0.84-0.94) or radiation therapy (HR = 0.92; 95% CI: 0.87-0.97). Conclusion: US-born patients had signifi cantly better OSCC survival compared to their foreign-born counterparts. This underscores the need for enhanced and sustained eff orts to improve access to healthcare among immigrant populations. In addition, oral health professionals such as general dentists, oral pathologists, and oral surgeons providing care to immigrant patients should ensure that reasonable eff orts are made to communicate eff ectively with patients with language barriers, especially in high-stake conditions such as cancer. This may help increase such patients' awareness of treatment provided and the critical issues regarding cancer care, resulting in enhanced treatment outcome. Keywords: foreign-born, immigrants, malignancy, nativity, oral cancer, survival