Racial and ethnic disparities in a state‐wide registry of patients with pancreatic cancer and an exploratory investigation of cancer cachexia as a contributor to observed inequities

Abstract

Pancreatic cancer (PC) is characterized by racial/ethnic disparities and the debilitating muscle‐wasting condition, cancer cachexia. Florida ranks second in the number of PC deaths and has a large and understudied minority population. We examined the primary hypothesis that PC incidence and mortality rates may be highest among Black Floridians and the secondary hypothesis that biological correlates of cancer cachexia may underlie disparities. PC incidence and mortality rates were estimated by race/ethnicity, gender, and county using publicly available state‐wide cancer registry data that included approximately 2700 Black, 25 200 Non‐Hispanic White (NHW), and 3300 Hispanic/Latino (H/L) Floridians diagnosed between 2004 and 2014. Blacks within Florida experienced a significantly (P < 0.05) higher incidence (12.5/100 000) and mortality (10.97/100 000) compared to NHW (incidence = 11.2/100 000; mortality = 10.3/100 000) and H/L (incidence = 9.6/100 000; mortality = 8.7/100 000), especially in rural counties. To investigate radiologic and blood‐based correlates of cachexia, we leveraged data from a subset of patients evaluated at two geographically distinct Florida Cancer Centers. In Blacks compared to NHW matched on stage, markers of PC‐induced cachexia were more frequent and included greater decreases in core musculature compared to corresponding healthy control patients (25.0% vs 10.1% lower), greater decreases in psoas musculature over time (10.5% vs 4.8% loss), lower baseline serum albumin levels (3.8 vs 4.0 gm/dL), and higher platelet counts (332.8 vs 268.7 k/UL). Together, these findings suggest for the first time that PC and cachexia may affect Blacks disproportionately. Given its nearly universal contribution to illness and PC‐related deaths, the early diagnosis and treatment of cachexia may represent an avenue to improve health equity, quality of life, and survival.

Paediatric reference values for total psoas muscle area

“…In addition, the obesity rates amongst children In Canada are lower than those in USA . This is relevant as ethnicity and obesity have been shown to impact tPMA muscle mass values . The tPMA values derived using our Toronto cohort represent a more diverse population, and we propose to be potentially more broadly generalizable.…”

Cancer health disparities in racial/ethnic minorities in the United States

“…AA/Bs have both a higher incidence [269][270][271][272][273] and mortality rate 270,271,[273][274][275] compared with NHWs as well as other populations, which has been documented for both younger and older adults (<50 years vs. >50 years) across all USA states other than Hawaii. 174,271,272 Nearly all racial/ethnic groups showed a steady increase in incidence over a 27-year period from 1988 to 2015, with AI/ANs (who had the lowest incidence of all race/ethnicity groups) showing the greatest increase over time and AA/Bs showing stable incidence rates.…”

The Florida Pancreas Collaborative Next-Generation Biobank: Infrastructure to Reduce Disparities and Improve Survival for a Diverse Cohort of Patients with Pancreatic Cancer

“…In 2020, 3570 (7.9%) of the 45,300 cancer-related deaths among Floridians will be due to PaCa and occur mainly in NHW, AA, and H/L [ 1 ], yet PaCa disparities research is limited in Florida’s diverse population. We used Florida Cancer Data System (FCDS) Registry data [ 15 ] to estimate age-adjusted PaCa incidence and mortality rates and found that AA had the highest incidence and mortality rates across genders, mirroring national disparities [ 16 ].…”