Abstract
BackgroundThe United States Census Bureau recommends distinguishing between “Asians” vs. “Native Hawaiians or Other Pacific Islanders” (NHOPI). We tested for prognostic differences according to this stratification in patients with prostate cancer (PCa) of all stages.MethodsDescriptive statistics, time-trend analyses, Kaplan–Meier plots and multivariate Cox regression models were used to test for differences at diagnosis, as well as for cancer specific mortality (CSM) according to the Census Bureau’s definition in either non-metastatic or metastatic patients vs. 1:4 propensity score (PS)-matched Caucasian controls, identified within the Surveillance, Epidemiology and End Results database (2004–2016).ResultsOf all 380,705 PCa patients, NHOPI accounted for 1877 (0.5%) vs. 23,343 (6.1%) remaining Asians vs. 93.4% Caucasians. NHOPI invariably harbored worse PCa characteristics at diagnosis. The rates of PSA ≥ 20 ng/ml, Gleason ≥ 8, T3/T4, N1- and M1 stages were highest for NHOPI, followed by Asians, followed by Caucasians (PSA ≥ 20: 18.4 vs. 14.8 vs. 10.2%, Gleason ≥ 8: 24.9 vs. 22.1, vs. 15.9%, T3/T4: 5.5 vs. 4.2 vs. 3.5%, N1: 4.4 vs. 2.8, vs. 2.7%, M1: 8.3 vs. 4.9 vs. 3.9%). Despite the worst PCa characteristics at diagnosis, NHOPI did not exhibit worse CSM than Caucasians. Moreover, despite worse PCa characteristics, Asians exhibited more favorable CSM than Caucasians in comparisons that focussed on non-metastatic and on metastatic patients.ConclusionsOur observations corroborate the validity of the distinction between NHOPI and Asian patients according to the Census Bureau’s recommendation, since these two groups show differences in PSA, grade and stage characteristics at diagnosis in addition to exhibiting differences in CSM even after PS matching and multivariate adjustment.
Highlights
According to the official recommendation of the United States (US) Census Bureau, Asian American and Pacific Islander (AAPI) race should be referred to as either being “Native Hawaiian or Other Pacific Islander” (NHOPI) or being “Asian” [1,2,3]
We hypothesized that NHOPI exhibit clinically and statistically meaningful differences in PSA, grade and stage at diagnosis as well as in cancer specific mortality (CSM) relative to Asians using Caucasians as control
To apply this to the currently used categories in the SEER database, we recoded the Asian or Pacific Islander (AAPI) category according to the reported ethnic subgroups, which resulted in an overall cohort (n = 380,705) across all disease stages of 355,485 Caucasian, 23,343 Asians and 1877 NHOPI eligible patients according to the Census Bureau’s recommendation
Summary
According to the official recommendation of the United States (US) Census Bureau, Asian American and Pacific Islander (AAPI) race should be referred to as either being “Native Hawaiian or Other Pacific Islander” (NHOPI) or being “Asian” [1,2,3]. By the year 2060, the Asian community is estimated to have more than doubled compared to an only moderate increase in the total US population [5] Despite their increasing numerous importance, Asian Americans remain among the most understudied racial minority groups in the US, because Asian race is composed of a variety of heterogeneous groups with a tremendous diversity in socioeconomic status, access to resources, migration patterns, and health characteristics [6]. Conclusions Our observations corroborate the validity of the distinction between NHOPI and Asian patients according to the Census Bureau’s recommendation, since these two groups show differences in PSA, grade and stage characteristics at diagnosis in addition to exhibiting differences in CSM even after PS matching and multivariate adjustment
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