Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data

Abstract

Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients’ data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11–1.35) and ACR (OR 2.02, 95% CI: 1.58–2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03–1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61–3.98 and sub-distribution HR 2.79, 95% CI: 2.05–3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.

Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics

“…Co-morbidities, including obesity and diabetes, were very common among HA and AI/AN patients in our study. We have previously shown persistent oncological health disparities and mortality rates among AIs/ANs and HAs, especially U.S.-born Mexican Americans in Arizona [ 5 , 13 ]. While a longer SWT and active surveillance are safe for the general population with low risk, the longer SWT may not be safe for high-risk patients, such as HAs and AIs/ANs.…”

“…Information on recurrence and mortality was not collected as a part of this study, and we were not able to evaluate the long-term effects of prolonged SWT. However, this study is unique and has a high representation of racial/ethnic minority groups, such as HAs and AIs/ANs with high RCC mortality, that have been previously underrepresented in RCC studies [ 5 , 8 , 39 ]. In our state, a large part of the state is categorized as medically underserved, including areas with high proportions of racial/ethnic minority residents.…”

“…In our state, a large part of the state is categorized as medically underserved, including areas with high proportions of racial/ethnic minority residents. This complicates access to urology care, radiology examination, surveillance, and surgical and oncology treatment for HA and AI/AN patients [ 5 ]. This may have impacted the composition of the study sample.…”

“…Due to geographic location (southern Arizona, USA), this study focused on HAs and AIs/ANs who also have a disproportionately higher burden of RCC [ 5 ]. Other racial/ethnic groups (African Americans and Asian Americans) that were underrepresented in the study (<5%), mixed-race individuals, and individuals without information on race/ethnicity were grouped together.…”

“…The purpose of this study was to assess if race/ethnicity was associated with longer SWT and upstaging at surgery in the pre-COVID-19 pandemic time. We focused on racial/ethnic disparities because renal cell carcinoma (RCC) disproportionately affects racial/ethnic minority groups, particularly Hispanic Americans (HAs) and American Indians and Alaska Natives (AIs/ANs) [ 5 , 6 , 7 ]. These racial/ethnic groups are also underrepresented in RCC health disparities research [ 8 ].…”