Abstract

Improper aggregation of Native Hawaiian and other Pacific Islander individuals with Asian individuals can mask Native Hawaiian and other Pacific Islander patient outcomes. A comprehensive assessment of cancer disparities comparing Asian with Native Hawaiian and other Pacific Islander populations is lacking.To compare comorbidity burden and survival among East Asian, Native Hawaiian and other Pacific Islander, South Asian, and Southeast Asian individuals with non-Hispanic White individuals with cancer.This retrospective cohort study used a national hospital-based oncology database enriched with Native Hawaiian and other Pacific Islander and Asian populations. Asian, Native Hawaiian and other Pacific Islander, and White individuals diagnosed with the most common cancers who received treatment from January 1, 2004, to December 31, 2017, were included. Patients younger than 18 years, without pathologic confirmation of cancer, or with metastatic disease were excluded. Data were analyzed from January to May 2022.The primary end points were comorbidity burden by Charlson-Deyo Comorbidity Index and overall survival (OS).In total, 5?955?550 patients were assessed, including 60?047 East Asian, 11?512 Native Hawaiian and other Pacific Islander, 25?966 South Asian, 42?815 Southeast Asian, and 5?815?210 White patients. The median (IQR) age was 65 (56-74) years, median (IQR) follow-up was 58 (30-96) months, and 3?384?960 (57%) were women. Patients were predominantly from metropolitan areas (4?834?457 patients [84%]) and the Southern United States (1?987?506 patients [34%]), with above median education (3?576?460 patients [65%]), and without comorbidities (4?603?386 patients [77%]). Cancers included breast (1?895?351 patients [32%]), prostate (948?583 patients [16%]), kidney or bladder (689?187 patients [12%]), lung (665?622 patients [11%]), colorectal (659?165 patients [11%]), melanoma (459?904 patients [8%]), endometrial (307?401 patients [5%]), lymphoma (245?003 patients [4%]), and oral cavity (85?334 patients [1%]) malignant neoplasms. Native Hawaiian and other Pacific Islander patients had the highest comorbidity burden (adjusted odds ratio [aOR], 1.70; 95% CI, 1.47-1.94) compared with Asian and White groups. Asian patients had superior OS compared with White patients for most cancers; only Southeast Asian patients with lymphoma had inferior survival (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.16-1.37). In contrast, Native Hawaiian and other Pacific Islander patients demonstrated inferior OS compared with Asian and White patients for oral cavity cancer (aHR, 1.56; 95% CI, 1.14-2.13), lymphoma (aHR, 1.35; 95% CI, 1.11-1.63), endometrial cancer (aHR, 1.30; 95% CI, 1.12-1.50), prostate cancer (aHR, 1.29; 95% CI, 1.14-1.46), and breast cancer (aHR, 1.09; 95% CI, 1.00-1.18). No cancers among Native Hawaiian and other Pacific Islander patients had superior OS compared with White patients.In this cohort study, compared with White patients with the most common cancers, Asian patients had superior survival outcomes while Native Hawaiian and other Pacific Islander patients had inferior survival outcomes. Native Hawaiian and other Pacific Islander patients had significantly greater comorbidity burden compared with Asian and White patients, but this alone did not explain the poor survival outcomes. These results support the disaggregation of these groups in cancer studies.

View details for DOI 10.1001/jamanetworkopen.2022.26327

View details for PubMedID 35960520