Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups

Jain, Bhav; Bajaj, Simar S.; Patel, Tej A; Vapiwala, Neha; Lam, Miranda; Mahal, Brandon A.; Muralidhar, Vinayak; Amen, Troy B.; Nguyen, Paul L.; Sanford, Nina N.; Dee, Edward Christopher

doi:10.1245/s10434-023-13339-0

Cited by 14 publications

(6 citation statements)

References 42 publications

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“…Recent work by Jain et al. described colon cancer trends with a focus on time to surgery and analytic stage in a disaggregated Asian population (with Hmong as a unique subpopulation) using NCDB data 33 . Their work did not identify a statistical difference in time to surgery (in stage 0–III colon cancer cases) compared to a NHW population but noted a trend towards a higher stage in the Hmong population, like our findings.…”

Section: Discussionsupporting

confidence: 65%

Survival of the Hmong population diagnosed with colon and rectal cancers in the United States

Walker,

Lor,

Lor

et al. 2024

Cancer Medicine

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BackgroundThe Hmong population constitutes an independent ethnic group historically dispersed throughout Southeast Asia; fallout from the Vietnam War led to their forced migration to the United States as refugees. This study seeks to investigate characteristics of the Hmong population diagnosed with in colorectal cancer (CRC) as well as survival within this population.MethodsCases of colon and rectal adenocarcinoma diagnosed between 2004 and 2017 were identified from the National Cancer Database (NCDB). Summary statistics of demographic, clinical, socioeconomic, and treatment variables were generated with emphasis on age and stage at the time of diagnosis. Cox‐proportional hazard models were constructed for survival analysis.ResultsOf 881,243 total CRC cases within the NCDB, 120 were classified as Hmong. The average age of Hmong individuals at diagnosis was 58.9 years compared 68.7 years for Non‐Hispanic White (NHW) individuals (p < 0.01). The distribution of analytic stage differed between the Hmong population and the reference NHW population, with 61.8% of Hmong individuals compared to 45.8% of NHW individuals with known stage being diagnosed at stage III or IV CRC compared to 0, I, or II (p = 0.001). However, there was no difference in OS when adjusting for potential confounders (HR 1.00 [0.77–1.33]; p = 0.998).ConclusionsHmong individuals are nearly a decade younger at the time of diagnosis of CRC compared to the NHW individuals. However, these data do not suggest an association between Hmong ethnicity and overall survival, when compared to the NHW population.

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Section: Discussionsupporting

confidence: 65%

Survival of the Hmong population diagnosed with colon and rectal cancers in the United States

Walker,

Lor,

Lor

et al. 2024

Cancer Medicine

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“…Disaggregating health data are an important step in identifying and addressing barriers in access to care within specific subpopulations. 31,32 Our findings highlight the differences in cervical cancer stage at presentation among Hispanic/Latinx subpopulations and the heterogeneity of this group. We identified significant differences in income and education between Hispanic/ Latinx subpopulations.…”

Section: Discussionmentioning

confidence: 62%

Region of origin and cervical cancer stage in multiethnic Hispanic/Latinx patients living in the United States

Dinicu,

Dioun,

Goldberg

et al. 2023

Cancer Medicine

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BackgroundHispanic/Latinx people have the second highest cervical cancer incidence rates in the U.S. However, there is a lack of disaggregated data on clinical outcomes for this diverse and populous group, which is critical to direct resources and funding where they are most needed. This study assessed differences in stage at diagnosis of cervical cancer among Hispanic/Latinx subpopulations and associated factors.MethodsWe analyzed patients with primary cervical cancer from 2004 to 2019 in the National Cancer Database. Hispanic/Latinx patients were further categorized into Mexican, Puerto Rican (PR), Cuban, Dominican, and Central/South American, as per standard NCDB categories, and evaluated based on stage at diagnosis and sociodemographic characteristics. Multinomial logistic regression quantified the odds of advanced stage at presentation. Regression models were adjusted for age, education, neighborhood income, insurance status, and additional factors.ResultsHispanic/Latinx cervical cancer patients were more likely to be uninsured (18.9% vs. 6.0%, p < 0.001) and more likely to live in low‐income neighborhoods (28.6% vs. 16.9%, p < 0.001) when compared to non‐Hispanic White populations. Uninsured Hispanic/Latinx patients had 37.0% higher odds of presenting with regional versus localized disease (OR 1.37; 95% CI, 1.19–1.58) and 47.0% higher odds of presenting with distant versus. Localized disease than insured patients (OR 1.47; 95% CI, 1.33–1.62). When adjusting for age, education, neighborhood income, and insurance status, PR patients were 48% more likely than Mexican patients to present with stage IV versus stage I disease (OR 1.48; 95% CI, 1.34–1.64).ConclusionDisaggregating health data revealed differences in stage at cervical cancer presentation among Hispanic/Latinx subpopulations, with insurance status as a major predictor. Further work targeting structural factors, such as insurance status, within specific Hispanic/Latinx subpopulations is needed.

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“…13 Jain et al demonstrated similar findings with an increased time to surgery among Chinese, Japanese, Filipino, Korean, and Vietnamese patients when compared to white patients with colon cancer. 14 There is a controversy as to whether rural populations suffer a delay in surgical treatment of colon cancer compared with urban populations. Bosma et al found the time to surgery is longer for rural patients with CRC than for urban patients while Gaffley et al and Honaker et al found no difference in time to surgery.…”

Section: Discussionmentioning

confidence: 99%

Race/Ethnicity and Social Determinants of Health and Their Impact on the Timely Receipt of Appropriate Operative Treatment of Colon Cancer

Tobin,

Dobbs,

Deslich

et al. 2024

The American Surgeon™

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Introduction Rates of appropriate surgical treatment of colon cancer are historically worse in traditionally marginalized populations. We sought to examine which social determinants of health may be associated with longer time to appropriate operative intervention. Methods The National Cancer Databank was queried for this retrospective study. Adult patients (18 to 90 years of age) diagnosed between 2004 and 2018 with single or primary, stage III colon cancer were included. Patient demographic variables included age at diagnosis, sex, ethnicity (Hispanic or non-Hispanic), comorbidity score, median household income, education status, rural/urban status, treatment facility type and location, and insurance status. Disease characteristics include stage (stage 3), primary site, surgical margins, tumor size, and number of nodes resected. Reported descriptive statistics include means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate and multivariate analyses were performed. Results A total of 134,601 individuals diagnosed with stage 3 colon cancer were included. Time to surgery in all cases had a mean of 26.4 ± 19.0 days. Multivariate analysis of time to surgery indicated that receiving surgery at a Community Cancer Program, Charlson-Deyo Score of 0, younger age, and non-Hispanic-White race/ethnicity are associated with decreased time to surgery ( P < .001). Conclusion Patients who receive surgery at a Community Cancer Program, have fewer comorbidities, have lower household income, are younger, and receive surgery within 50 miles of their primary residence are more likely to have timely surgery.

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Colon Cancer Disparities in Stage at Presentation and Time to Surgery for Asian Americans, Native Hawaiians, and Pacific Islanders: A Study with Disaggregated Ethnic Groups

Cited by 14 publications

References 42 publications

Survival of the Hmong population diagnosed with colon and rectal cancers in the United States

Survival of the Hmong population diagnosed with colon and rectal cancers in the United States

Region of origin and cervical cancer stage in multiethnic Hispanic/Latinx patients living in the United States

Race/Ethnicity and Social Determinants of Health and Their Impact on the Timely Receipt of Appropriate Operative Treatment of Colon Cancer

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