Esophageal cancer in Hispanic patients: A demographic analysis of the National Cancer Database.

Abstract

6561 Background: Hispanics are the fastest-growing minority accounting for 18% of the US population. The National Cancer Institute estimated 17,290 new cases of esophageal cancer (EC) in the US in 2018. Hispanics are reported to have lower EC prevalence. We sought to interrogate the demographic patterns of EC in Hispanics. Secondary objective was to examine evidence of socioeconomic disparities and differential therapy. Methods: We queried the National Cancer Database to identify patients with EC between 2005–2015. Patients were divided into two groups, Hispanic vs Non-Hispanic (NH). Demographics compared were age, sex, tumor data, surgical intervention, type of treatment, insurance status, income, residence area, and Charlson/Deyo score. Pearson’s Chi-square test was used to compare categorical variables. Groups were matched by propensity score-matched analysis (PSM). Survival analysis was estimated by the Kaplan-Meier method and associated log-rank test. P-value ≤0.05 was considered significant. Results: We identified 85,004 patients with EC; 3,205 were Hispanic (3.8%). In this US population we identified significant disparities between the Hispanic and NH groups. Statistically significant differences among Hispanics included higher prevalence of squamous EC (24.7% vs 19.6%), higher likelihood of stage IV cancer diagnosis (40.7% vs. 34.8%), younger age, higher uninsured status (10.4% vs 3%) with income < $38,000 (26.4% vs 15.9%), and Charlson/Deyo score 0 (72.3% vs 70.7%) when compared to NH. However, Hispanics were less likely to have surgical intervention (29% vs 36.3) and overall less likely to receive any type of treatment (30.1% vs 26.1%). PSM showed that any treatment, insurance status and lower income were predictors of survival. Treated Hispanics survived longer than NH (median survival 17 vs 15 months). Overall survival at 5 years was 22% vs 17%, respectively, p < 0.05. Conclusions: Despite lower prevalence of EC in Hispanics compared to NH, there is a disproportionately higher number of metastatic and untreated cases among Hispanics. This disparity may be explained by Hispanics' limited access to medical care exacerbated by their socioeconomic and insurance status. Further clinical and epidemiologic research is warranted to reveal other factors impacting these health disparities.