Non-small cell lung cancer disparities in stage at presentation and treatment status for Asian American, Native Hawaiian, and Pacific Islander females.

Abstract

e18526 Background: Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) represent the fastest-growing racial group in the United States. While often described in aggregate as one of the healthiest populations, large variations in the social determinants of health and subsequent health outcomes exist within the AANHPI community. We identified differences in stage at presentation and treatment status among AANHPI women with non-small cell lung cancer. Methods: Between 2004 and 2016, a retrospective cohort study was performed using the National Cancer Database (NCDB) with 522,361 female patients with newly diagnosed non-small cell lung cancer (NSCLC). Asian subgroups were distinguished as Chinese, Japanese, Filipino, Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian, Pakistani, and Pacific Islander. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) with 95% CI of presenting at stage IV disease and not receiving treatment. Effect measure modification (EMM) by age was also analyzed in all models. Results: Among 522,361 women, AANHPI women were more likely to present with stage IV disease at presentation when compared to White women (54.32% vs 40.28%, aOR = 1.54, 95%CI = 1.45-1.64, p < 0.001). All AANHPI subgroups also had greater odds of presenting with stage IV diseases when compared to White populations: Chinese (aOR = 1.49, 95%CI = 1.38-1.61, p < 0.001), Japanese (aOR = 1.22, 95%CI = 1.09-1.37, p < 0.001), Filipino (aOR = 1.63, 95%CI = 1.49-1.78, p < 0.001), Korean (aOR = 1.49, 95%CI = 1.30-1.70, p < 0.001), Vietnamese (aOR = 1.74, 95%CI = 1.54-1.97, p < 0.001), Laotian (aOR = 2.24, 95%CI = 1.49-3.37, p < 0.001), Kampuchean (aOR = 1.61, 95%CI = 1.06-2.46, p = 0.027), Thai (aOR = 1.64, 95%CI = 1.17-2.31, p = 0.004), Asian Indian (aOR = 1.50, 95%CI = 1.30-1.73, p < 0.001), and Pacific Islander (aOR = 1.50, 95%C = 1.20-1.88, p < 0.001). In EMM analysis, Asian women aged younger < 65 years were more likely to present with stage IV diseases (p = 0.030 for interaction). Asian women were also more likely not to receive treatment (7.01% vs. 8.80%, 95%CI = 0.84-1.09, p = 0.497). Vietnamese women (aOR = 1.30, 95%CI = 1.06-1.58, p = 0.010) showed significant differences compared to White women. Conclusions: Differences in stage at presentation and treatment status in women with NSCLC were observed among AANHPI subgroups when populations were disaggregated. Efforts are needed to elucidate the barriers these populations face that may explain the observed delays in diagnosis. Further disaggregated study of AANHPI subpopulations is needed to reduce inequities in lung cancer.