Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona.

Francine C Gachupin,Chiu-Hsieh Hsu,Kathryn R Pulling,Ken Batai,Ava C Wong,Juan Chipollini,Benjamin R Lee,Alejandro Cruz,Celina I Valencia

doi:10.3390/ijerph19031185

Abstract

American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients’ demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07–2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08–2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21–2.76 and HR 1.59 95% CI: 1.30–1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.

Highlights

Introduction published maps and institutional affilAcross the United States (U.S.), American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW) [1,2,3]
Both AI/AN and HA were more likely to receive no treatment compared to NHW; neighborhood characteristics likely explained the findings for AI/AN but only partially for Mexican Americans
AI/AN and HA were diagnosed 6 years younger; they were more likely to receive no treatment, or if treatment was received, it was more likely to be radical nephrectomy, which was associated with higher overall mortality

Summary

Introduction

Across the United States (U.S.), American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW) [1,2,3]. HA have higher incidence and mortality in Arizona. Analysis of RCC suggests that sociodemographic factors, such as location of residence (urban/rural) and neighborhood factors, including Census-track high school graduation, unemployment, and poverty rates [7], have influenced cancer diagnosis in Arizona. These two racial/ethnic minority groups are underrepresented in iations

Objectives

Methods

Results

Discussion

Conclusion