Health disparity viewed from public historic cancer mortality data in the US: Advocacy for gastrointestinal cancers, for tailored prevention measures, and for inter-agency population data harmonization.

Abstract

152 Background: We searched public datasets released by CDC to answer the question ”Can we have a bird’s-eye view of health disparity in cancer care in the US?” By looking into historic data, we hope to identify not only health disparity reflected by the different cancer mortality rates for major cancer types, but also signs of missing data. Methods: We analyzed 2016-2020 US Cancer Statistics (USCS) cancer burden data to assess cancer disparity as reflected by rates of death in different races or ethnicities. Since the 2022 AACR report on cancer in Asian Americans raised concerns, we then looked into the “Single Race 15” grouping for the underlying cause-of-death data in WONDER@CDC to count liver cancer deaths (ICD10: C22) 2018-2021 among 6 Asian minority groups with population data from 2021 Census ACS data. 2020 GLOBOCAN estimated liver cancer mortality data were also compared. With anecdotal stories suggesting immigrants may seek end-of-life care in the birth country to access culture-concordant services, we looked into how cancer deaths abroad was reported. Results: Gastrointestinal (GI) cancers emerged as an area of cancer health disparity from USCS data. 5 GI cancers (colon and rectum, pancreas, liver and bile duct, stomach, and esophagus) contributed to 1/4 of US cancer deaths, and cancers in the pancreas, liver and bile duct, and esophagus still have poor outcomes. Black non-hispanic Americans are more likely to die from cancers of colon/rectum or pancreas. All minority races or ethnicities are more likely to die from cancers in liver and bile duct, or stomach than white non-Hispanic Americans. Cancers in colon and rectum, liver and bile duct, or stomach also cause high numbers of death in US under-50 population. Liver cancer mortality of US East Asian alone groups shown in the table were lower than GLOBOCAN estimated ASR of 16.1, with the greatest discrepancy in the Chinese (9.1 vs 17.2). Difference between the Vietnamese and Asian Indians may reflect that liver cancer is #1 cause of death in Vietnam, or HepB infection is low in India. Census data excluded expat US citizens, and consulate reports of death abroad have neither cause of death nor race/ethnicity data. Conclusions: We identified gastrointestinal cancers as a focus for cancer health disparity advocacy. Divergent risks for liver cancer in Asian Americans call for tailored prevention measures. Cross-agency death abroad data harmonisation to include race/ethnicity information will complete views of cancer mortality data in US. [Table: see text]