Background: Despite recent advances in the management of head and neck cancer (HNC), there is little evidence of improvement in 5-year overall survival (OS) over the last few decades. Ethnicity, age, and socioeconomic status have all been associated with outcomes in HNC. We examine the survival disparities and trends of HNC in major ethnicities using the largest population based database. Methods: Frequency, rate and survival sessions (Kaplan-Meier, age adjusted) on demographics and survival trends were performed and compared among Non-Hispanic-White (NHW), African-American (AA), Hispanics, Asians and Pacific-Islanders (A/PI) and Asian-Indian and Alaskan-Natives (AI/AN) with SEER*Stat using SEER 1973-2010 data. Results: A total of 247,310 HNC patients were reported from 1973-2010 in SEER database. The primary sites were lip (11%), Tongue (27%), floor of mouth (8%), gum and other parts of mouth (16%), tonsils (15%), oropharynx (4%), nasopharynx (7%), hypopharynx (9%) and others (3%). Overall, 71% patients were male. The incidence rates per 100,000 were reported highest in AA (16.4) compare to NHW (15.3), Hispanics (9.6), A/PI (9.7), and AI/AN (7.8). There were 40% stage IV cases which were equally distributed across all ethnicities. After adjusting for age, stage and year of treatment, AA has significantly (p<0.05) inferior 5-year OS (41.8%) compared to NHW (60.8%), Hispanics (59.3%), A/PI (62%) and AI/AN (50.2%).The OS rates in A/PI and AI/AN have improved by 17.5% and 14.6% (p<0.05) over last 37 years respectively. In contrast, the AA had 6.1% decreased OS (p<0.05) from 1973 to 2010. In subset analysis, OS for stage IV in AA is poor (21%) compare to other ethnicities (p<0.001). Conclusions: According to SEER analysis, the OS in AA has decreased significantly from 1973 to 2010 and they continue to have dismal prognosis. The underlying causes are largely unknown. However, biologic/genetic and epigenetic factors, access to health care, socioeconomic status may play a role. Prospective studies are needed to define these factors in AA and to formulate treatment strategies that would improve survival outcome in AA.