Asian And Pacific Islander Research Articles

Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations

BackgroundCardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups. MethodsWe identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression. ResultsOf the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status. ConclusionsThere is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.

Discrimination Experiences among Asian American and Pacific Islander Adults during the COVID-19 Pandemic and Their Association with Mental Health Outcomes: Updated Findings from the COMPASS Study.

Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue. Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes. Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health. The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

Differential effects of a social work staffing intervention on social work access among rural and highly rural Veterans: A cohort study.

To evaluate the impact on rural Veterans' access to social work services of a Department of Veterans Affairs (VA) national program to increase social work staffing, by Veterans' rurality, race, and complex care needs. Data obtained from VA Corporate Data Warehouse, including sites that participated in the social work program between October 1, 2016 and September 30, 2021. The study outcome was monthly number of Veterans per 1000 individuals with 1+ social work encounters. We used difference-in-differences to estimate the program effect on urban, rural, and highly rural Veterans. Among rural and highly rural Veterans, we stratified by race (American Indian or Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White) and complex care needs (homelessness, high hospitalization risk, and dementia). We defined a cohort of 740,669 Veterans (32,434,001 monthly observations) who received primary care at a participating site. Average monthly social work use was 8.7 Veterans per 1000 individuals. The program increased access by 49% (4.3 per 1000; 95% confidence interval, 2.2-6.3). Rural Veterans' social work access increased by 57% (5.0; 3.6-6.3). Among rural/highly rural Veterans, the program increased social work access for those with high hospitalization risk by 63% (24.5; 18.2-30.9), and for Veterans experiencing homelessness, 35% (13.4; 5.2-21.7). By race, the program increased access for Black Veterans by 53% (6.1; 2.1-10.2) and for Asian Veterans by 82% (5.1; 2.2-7.9). At rural VA primary care sites with social work staffing below recommended levels, Black and Asian Veterans and those experiencing homelessness and high hospitalization risk may have unmet needs warranting social work services.

Regular Physician Access and Obesity Status Among Underserved Asian and Pacific Islander American Immigrants in Los Angeles.

According to prior research, Asian and Pacific Islander American (APIA) immigrants often refrain from seeking health care unless necessitated by medical conditions. Utilizing data from health screenings conducted in APIA immigrant enclaves in Los Angeles, we hypothesize that poorer obesity status would predict higher rates of regular physician access. Analyses involved objectively measured percent body fat (%BF) and survey responses collected between 2011 and 2019. We assessed the association between obesity status and regular physician access, adjusting for insurance status, demographic, and socioeconomic factors. The study population (n = 4102) primarily consisted low-income, low English proficiency APIAs. Participants with a regular physician were significantly more likely to be obese compared to participants without (adjusted odds ratio [aOR] = 1.28). This association may suggest that care was sought reactively rather than proactively within this community. Interventions with emphasis on cultural competency and language services may encourage preventative care utilization among this understudied community.

Methamphetamine Use in Psychiatric Emergency Services and Among Asian American and Pacific Islander Populations.

Addressing the methamphetamine epidemic will require a more complete understanding of its effect on healthcare systems and of the populations at risk. The objective of the study was to assess the impact of methamphetamine use on psychiatric emergency services outcomes and on Asian American (AA) and Pacific Islander (PI) populations, a historically overlooked population in substance use research. A retrospective chart review was performed for all visits to a large level I trauma center in urban Hawaii from 2007 to 2019 that required psychiatric emergency services and in which urine drug screening was completed (N = 44,658). Demographic characteristics and emergency room courses were compared between amphetamine-positive and amphetamine-negative visits. The proportion of amphetamine-positive visits approximately doubled from 13.3% in 2007 to 25.5% in 2019. Amphetamine-positive visits were more likely to involve arrival by law enforcement (38.3% vs 27.2.%, P < 0.001), require intramuscular psychotropic medications (17.3% vs 12.3%, P < 0.001), and have longer emergency department lengths of stay (median, 420 vs 372 minutes, P < 0.001). Visits by Native Hawaiian and Hispanic/Latino patients had the highest rate of amphetamine positivity, while visits by Chinese and Korean patients had the lowest. The findings reveal a concerning rise in amphetamine positivity that is associated with increased resource utilization. There was also significant variability in the rate of amphetamine positivity within the AA and PI population, a group of ethnicities often analyzed as a single entity in previous studies. Culturally sensitive interventions may curb the methamphetamine epidemic's effect on healthcare systems and vulnerable populations.

Disaggregating U.S. Asian and Pacific Islanders: Colorectal cancer

BackgroundColorectal cancer remains a public health concern as the 4th most common cancer in the US. Incidence and mortality have been observed to differ between races; however, Asian and Pacific Islander ethnicities are often documented in aggregate. Recognizing that these groups are heterogeneous, this study seeks to disaggregate Native Hawaiian from the broader “Asian/Pacific Islander” group and examine disparate outcomes in colorectal cancer. MethodsDe-identified data from the Hawaii Tumor Registry was queried to evaluate colorectal cancer in the state of Hawaii. Primary outcomes were cancer stage at diagnosis, first course of therapies received, and duration of survival from diagnosis. Chi-square analyses were performed for differences in categorical variables. Results7943 Hawaii residents were diagnosed with colorectal cancer in 2008–2018 with 1151 (14.5 %) patients identifying as Native Hawaiian. Native Hawaiians were less likely to present with localized cancer (36.7 % vs. 41.7 %; p = 0.002) and more likely to be diagnosed with distant stage cancer compared to non-Native Hawaiians (25.2 % vs. 17.67 %; p < 0.0001) and, among those with distant metastases, more likely to receive chemotherapy (68.3 % vs. 61.1 %; p = 0.029). No significant differences were observed between races on analysis of CRC-specific mortality. ConclusionSignificant differences exist between disaggregated Asian and Pacific Islander ethnic groups. Native Hawaiians are observed to present with more advanced cancer at the time of diagnosis in comparison to ethnicities. Disaggregating these groups reveals racial and ethnic disparities that may inform public health measures. SynopsisDisaggregating Asian and Native Hawaiian and Pacific Islander groups reveals disparities in colorectal cancer. Native Hawaiians presented with more advanced disease across all studied ethnic groups. No significant differences were observed in colorectal cancer specific mortality across groups.

An epidemiological study of multisystem inflammatory syndrome in children (MIS-C) and young adults among COVID-19-positive patients - data from National Inpatient Sample database.

During the pandemic of COVID-19, a novel atypical set of clinical findings was seen among several children with recent or current exposure to the virus. It was termed the "multisystem inflammatory syndrome in children" (MIS-C). Our study used the 2021 National Inpatient Sample to study the associations of sex, race, and age with the incidence of MIS-C among COVID-19-positive children. Out of 69,440 COVID-19-positive children, 2,790 (4.0%) reported MIS-C. The incidence of MIS-C was highest among those aged 8 years old (17,130 MIS-C cases per 100,000 COVID-19 patients), Asian or Pacific Islanders (API) (5,346 MIS-C per 100,000 COVID-19 cases), and males (4,734 cases per 100,000 COVID-19 cases). Furthermore, 7.9% of MIS-C cases met the classification of Kawasaki disease.

The Impact of Race and the Affordable Care Act on Thyroid Carcinoma Outcomes: A National Cancer Database Study.

To assess the impact of race and the Affordable Care Act (ACA) of 2010 on disease presentation and overall survival for patients with well-differentiated thyroid carcinoma. Cross-sectional study of patients (n = 51,078) who underwent partial or total thyroidectomy with or without postoperative radioactive iodine (RAI) for well-differentiated thyroid carcinoma between 2004 and 2018 in the National Cancer Database (NCDB). Cumulative survival (CS) was assessed with Cox proportional hazard regression analyses. There were significant disparities in disease presentation at the time of diagnosis, with Black, Asian/Pacific Islander (API), and Hispanic patients were more likely to have metastatic disease (p < 0.001) and higher TNM stage (p < 0.001) at the time of diagnosis compared to White patients. Black patients had significantly increased risk of death (HR 1.147, 95%CI 1.021-1.289) but API patients had improved CS (HR 0.730, 95% CI 0.608-0.877) compared to White patients. Passage of the ACA was associated with lower risk of mortality, regardless of whether patients lived in states that did not expand Medicaid (HR 0.866, 95% CI 0.823-0.910) or whether they lived in expansion states (HR 0.818, 95% CI 0.758-0.884). Racial disparities significantly impact thyroid carcinoma diagnosis and treatment in the United States but have improved over time. Both expansion and non-expansion states had improved survival outcomes over time, and suggesting analysis of the ACA's long-term impact and ability to address health inequities is still warranted. 3 Laryngoscope, 134:4421-4430, 2024.

Disparities in patients with HER2-positive breast cancer receiving optimal treatment: Analysis of the real-world ASCO CancerLinQ dataset.

e13739 Background: Racial/ethnic disparities in locoregional second breast cancer events (SBCE) in patients (pts) with HER2-positive (HER2+) breast cancer (BC) are not well defined. We examined rates of SBCE and overall survival (OS) by race and ethnicity in the ASCO CancerLinQ Discovery (CLQD) real-world dataset in HER+ BC pts receiving optimal and not-optimal treatment. Methods: CLQD was used to identify pts undergoing surgery for stage I-III HER2+ BC from 2005-2022. Race/ethnicity were self-reported. Optimal treatment was defined as HER2-directed therapy for stage II-III HER2+ BC starting in 2008, adjuvant endocrine therapy for hormone-receptor positive (HR+) HER2+ BC, radiation after lumpectomy, and regional nodal irradiation for N2-N3 disease. The primary endpoint was SBCE defined as a second event in the ipsilateral or contralateral breast or axilla, with OS as a secondary endpoint. Kaplan-Meier analysis was used to estimate SBCE-free survival and OS. Results: Of 8,795 stage I-III HER2+ BC pts, 5,487 (62.4%) were Non-Hispanic White (NHW), 1,083 (12.3%) Non-Hispanic Black (NHB), 418 (4.7%) Hispanic, 323 (3.7%) Asian or Pacific Islander (API), and 1,484 (16.9%) other/unknown. Overall, 39.2% had HR-HER2+ and 60.7% had HR+HER2- BC. NHW pts were the most likely to present with stage I disease (40.2% vs 31.9%, 29.0%, and 30.3% of NHB, Hispanic, and API pts, respectively, p&lt;0.01) and less likely to be age &lt;50 at diagnosis (26.1% vs 32.3%, 41.0%, and 36.6% in NHB, Hispanic, and API, p&lt;0.01). Overall, 54.2% of HER2+ BC pts received optimal treatment: 54.1%, 60.2%, 60.5%, and 58.8% of NHW, NHB, Hispanic, and API pts (p&lt;0.01). Neoadjuvant HER2-therapy was given in 42.4%, 46.3%, 53.8%, and 51.2% of NHW, NHB, Hispanic, and API pts (p&lt;0.01) and endocrine therapy in 64.7%, 56.8%, 59.3%, and 54.7%, respectively (p&lt;0.01). 5-yr SBCE-free survival and OS are shown (Table). SBCE-free survival was not statistically different by race and ethnicity in optimally or non-optimally treated pts. Optimal treatment increased OS by 4.1% and 0.9% in NHW and NHB pts with HR-HER2+ BC and 2.4% and 8.9% in NHW and NHB pts with HR+HER2+ BC. Conclusions: Differences in OS, but not SBCE, were seen by race/ethnicity in HER2+ BC. OS differences were not completely mitigated by receipt of optimal treatment. [Table: see text]

Asian and Pacific Islander cancer mortality trends in the United States between 1999-2020.

e23307 Background: The Asian and Pacific Islander (API) population is the fastest growing in the United States, composing nearly 7% of the US population. Although cancer is the second leading cause of death overall in the U.S., it is the leading cause of death in the API population. Despite this, no study has assessed trends in cancer mortality in API individuals in the US. Our aim was to analyze differences and trends in API cancer mortality in the U.S. between 1999 to 2020. Methods: The CDC WONDER database was used to determine mortality statistics for patients, classified as non-Hispanic Asian or Pacific Islander, with cancer (ICD-10 codes C00-C97) as the underlying cause of death between 1999 and 2020. Age-adjusted mortality rates (AAMR) were calculated per 100,000 deaths, and were stratified by cancer type, sex, population density, U.S. census region, and age. Joinpoint regression software was used to identify temporal trends. Average annual percent change (APC) was considered statistically significant if p &lt; 0.05. Results: Between 1999 and 2020, cancer accounted for 305,386 deaths in API individuals. During this period, there was a 30% decrease in mortality due cancer and a decrease in APC of -1.5% (p &lt; 0.05). When stratified by cancer site, the largest decrease in APC was in stomach cancer at -3.7% (p &lt; 0.05), and the largest increase was in uterine cancer at 2.6% (p &lt; 0.05). In 1999, males experienced an overall cancer-related AAMR of 151, 48% higher than females at 103; however, by 2020 these differences reduced, with males having a cancer-related AAMR of 105.6 vs API females of 80.9, a 25% difference. Males experienced a larger decrease in APC (-1.8%, p &lt; 0.05), compared with females (-1%, p &lt; 0.05). Rural populations had the largest cancer-related AAMR (113.0) and largest drop in APC (-2%, p &lt; 0.05), compared with urban groups with a cancer-related AAMR of 106.7 and APC drop (-1.3%, p &lt; 0.05). The highest cancer related AAMRs was seen in lung cancer (24.3 in urban vs 25.4 in rural). Liver-cancer related AAMR was highest in urban populations at 10.4 and lowest in rural populations at 8.2. Western census regions had the highest AAMR at 113.7 with an APC decrease of –1.4% and Southern census regions had the lowest AAMR at 90.5 with an APC decrease of –1.2%. Adults aged &gt; 65 experienced the highest cancer related AAMR at 588.2, and adults aged 25-44 demonstrated the lowest AAMR at 14.7. However, adults aged 25-44 experienced the largest decrease in APC at -2% (p &lt; 0.05), compared with adults aged &gt; 65 at -1.4% (p &lt; 0.05). Conclusions: Our study identifies a significant decrease in cancer mortality in API individuals between 1999 and 2020. The largest decrease seen was in stomach cancer; however, uterine cancer mortality has increased. Notably, liver cancer mortality was higher in urban rather than rural groups. Further studies may examine differences amongst API and other racial groups, and potential sources for the disparities seen amongst API individuals.

A two-decade trend analysis of in-hospital outcomes and racial/ethnic disparities among hospitalized patients with lung cancer in the United States.

11035 Background: Previous research has focused largely on the disease and healthcare cost burden of lung cancer (LC),however, long-term trends of hospitalizations among LC patients (pts) in the US are limited. We aimed to describe longitudinal trends in in-hospital outcomes among hospitalized LC pts, overall and by race/ethnicity. Methods: We analyzed data from the National Inpatient Sample database, spanning 1998 to 2020. The study cohort included pts aged ≥18 years with a principal LC diagnosis. We assessed four in-hospital outcomes: 1) hospitalization, 2) mortality, 3) length of stay (LOS), and 4) total hospitalization charges (THCs). THCs were adjusted for inflation using the Medicare Hospital Care Consumer Price Index.To quantify trends, we performed weighted analyses (weighted means or proportions) and calculated P-trend using Cochran-Armitage or Jonckheere-Terpstra tests. Results: Of 791,100 pts (mean age 68.2 years), 80.4% were White, followed by 11.9% Black, 4.7% Hispanic, and 3.0% Asian or Pacific Islander (API). Among US hospitalized pts in 1998, 0.54% had a principal LC diagnosis, with hospitalization rates having decreased to 0.37% in 2020 ( P-trend&lt;.001). By race/ethnicity, the LC hospitalization rate for White pts declined from 0.53% in 1998 to 0.39% in 2020; for Black pts, it declined from 0.35% to 0.26%; and for Hispanic pts, it declined from 0.18% to 0.12% (all P-trend&lt;.001). In contrast, the hospitalization rate for API pts increased from 0.30% in 1998 to 0.38% in 2020 ( P-trend&lt;.001). The overall LC-specific in-hospital mortality rate declined drastically from 15.9% in 1998 to 6.2% in 2020 ( P-trend&lt;.001); a similar pattern was observed across racial/ethnic groups. The LOS reduced from an average of 7.9 days in 1998 to 5.9 days in 2020 ( P-trend&lt;.001). By race/ethnicity, the LOS for White pts decreased from 7.8 days in 1998 to 5.2 days in 2020; for Black pts, it decreased from 9.0 to 7.0 days; for Hispanic pts, it decreased from 8.8 to 6.7 days; and it declined from 8.7 to 5.9 days in API pts (all P-trend&lt;.001). THCs rose significantly from $39,706 in 1998 to $92,734 in 2020 ( P-trend&lt;.001). In White pts, THCs rose from $39782 to $89,681; from $41,235 to $91,792 in Black pts; from $49,444 to $119,386 in Hispanic pts; and from $52,779 to $112,365 in API pts (all P-trend&lt;.001). Moreover, the odds of female pts hospitalized with LC was higher (AOR=1.47, 95% CI=1.40-1.54, P&lt;.001) in 2020 compared to 1998. Conclusions: In this racially diverse hospitalized LC cohort, LOS, rates of hospitalizations, and mortality rates have declined, while THCs have risen significantly, over the last 20 years. API and female pts bore a heavier burden of hospitalizations. Our findings suggest the need for targeted healthcare interventions or policies to reduce THCs and hospitalization disparities in LC pts.

Racial/ethnic disparities in healthcare utilization, post-operative outcomes, and overall survival for IDH-wildtype glioblastoma stratifying by MGMT promoter methylation status.

2081 Background: Glioblastoma is the most common malignant primary brain tumor and molecular profiles such as IDH1/2 and MGMT promoter methylation status have significant influence on survival outcomes. There is no "real-world" study has investigated the racial/ethnic disparities in healthcare utilization and outcomes for IDH-wildtype glioblastoma patients with MGMT promoter methylation status. Methods: A total of 21971 IDH-wildtype glioblastoma patients ( MGMT promoter-methylated: 41.5%, 9110/21971) were derived from the National Cancer Database (NCDB, 2018-2021). Race/Ethnicity was grouped into Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Asian/Pacific Islander (API), American Indian/Alaska Native (AIAN), Hispanic, and Others. Overall survival (OS) was set as primary outcome. Healthcare utilization and post-operative outcomes are secondary endpoints. Multivariable logistic regression models, Kaplan-Meier methods, and Cox proportional hazards models were performed for post-operative outcomes, healthcare utilization, and overall survival. Results: Compared to NHW, AIAN were 78% more likely to have MGMT promoter methylation after adjusting age and gender (aOR=1.78, p=0.030). API and Hispanic were significantly less likely to undergo GTR over STR comparing to NHW. The odds of receiving chemotherapy and RT for race/ethnicity minorities patients were significantly lower than NHW (Chemotherapy: NHB: aOR=0.79, AIAN: aOR=0.57, Hispanic: aOR=0.83; RT: NHB: aOR=0.88, Hispanic: aOR=0.80). The median OSs by race/ethnicity (NHW, NHB, API, AIAN, Hispanic, and Others, respectively) were: 11.5, 12.3, 14.5, 9.2, 13.6, and 15.6, months ( MGMT promoter-unmethylated, p&lt;0.001), 15.9, 18.8, 23.7, 14.8, 19.6, and 15.5, months ( MGMT promoter-methylated, p&lt;0.001). After adjusting the covariates, NHB, API, and Hispanic experienced significantly lower risk of death comparing to NHW (aHR=0.82, 0.66, and 0.75, all p&lt;0.001). Similar results were validated in stratification analysis by MGMT promoter methylation status, except MGMT promoter-unmethylated AIAN experienced 70% higher risk of death than NHW (aHR=1.70, p=0.021). Conclusions: Our findings suggests that racial/ethnic disparities exist in healthcare utilization, postoperative outcomes, and overall survival in IDH-wildtype glioblastoma population.

Improving ethnic and racial diversity in biomarker-driven clinical trials: A proof of concept with the BASECAMP-1 master prescreening study of patients with high-risk solid tumors with human leukocyte antigen-A*02 (HLA-A*02) loss of heterozygosity (LOH).

1604 Background: Diversity in clinical studies is essential to address health disparities, but racial and ethnic minorities are often underrepresented in clinical studies, especially in precision medicine studies using genetic data (1). BASECAMP-1 (NCT04981119) is an ongoing prescreening study to identify patients with unresectable advanced or metastatic solid tumors and tumor-associated HLA-A*02 LOH for the EVEREST-1 and -2 Tmod chimeric antigen receptor T-cell therapy trials. When enrollment began in 2021, eligibility for Part 1 was restricted to patients with germline HLA-A*02:01 based on preclinical data. Additional analysis revealed the blocker in the Tmod construct had activity across HLA-A*02 subtypes (Mock, et al. Mol Ther Oncolytics.2022). Eligibility for Part 1 was then expanded to all HLA-A*02 subtypes, allowing enrollment of more diverse patient populations. HLA-A*02 allele subtypes vary by ethnicity and race; the frequency of HLA-A*02:01 is 96% in non-Hispanic Whites, but ranges from 53% to 73% in other ethnicities and races. The frequency of all other HLA-A*02 allele subtypes (HLA-A*02:XX) is &lt;5% in non-Hispanic Whites but up to 66% in other ethnicities and races (2,3). Methods: Patients eligible for BASECAMP-1 were identified at United States study sites. All patients screened before January 16, 2024, for Part 1 were included for demographic and central lab HLA-A typing. The % increase in eligibility and % of heterozygous HLA-A*02 patients with HLA-A*02:XX were calculated by ethnicity and race. Results: A total of 1124 patients were screened for germline HLA-A*02 typing; 431 patients were HLA-A*02:01 heterozygous, of whom 37 (9%) were Hispanic, 14 (3%) African American (AA), 2 (&lt;1%) American Indian or Alaska Native, 17 (4%) Asian or Pacific Islander (API), and 324 (75%) non-Hispanic White (Table). The eligibility expansion identified 62 patients with HLA-A*02:XX heterozygosity, of whom 6 (10%) were Hispanic, 6 (10%) AA, 19 (31%) API, and 25 (40%) non-Hispanic White. Conclusions: By expanding enrollment to include HLA-A*02:XX, 16% more Hispanic, 43% more AA, and 112% more API patients were identified, improving the diversity in this trial compared with that of initial enrollment. 1. Aldrighetti, et al. JAMA Netw Open 2021. 2. Ellis, et al. Human Immunol. 2000. 3. Gragert, et al. Human Immunol.2013. Clinical trial information: NCT04981119 . [Table: see text]

Predictors of mood-related psychiatric disorders after cancer diagnosis.

e23043 Background: Mood-related psychiatric disorders (MRPDs) such as anxiety and depression are more common among cancer patients vs. the general population and are related to decreased quality of life and poor cancer survival. However, individual risk factors for MRPDs among cancer patients are poorly understood. This study characterized individual predictors of a new MRPD after cancer diagnosis, with a focus on individual behavioral risk factors (IBRFs) (ie., tobacco use and human papillomavirus [HPV]-association). Methods: Single-center retrospective cohort study of 11,712 patients with newly diagnosed breast, prostate, colon, lung, oropharyngeal, anorectal, gynecologic (cervical, vaginal, and vulvar), or penile cancers between 2009-2020. Patients with breast, prostate, and colon cancer were used as controls because of the lack of an association with IBRFs. The primary outcome was a new MRPD post-cancer diagnosis, ascertained via electronic health record data and using ICD10 codes for MRPDs. Covariates included age, sex, race/ethnicity, sexual orientation, disease stage at diagnosis, and IBRFs. We conducted a time-to-event analysis to assess risk factors for MRPDs using a Cox proportional hazards model. Results: The average age of participants was 63 years (SD = 12 years). Most of the study sample was female (59%), non-Hispanic White (72%), heterosexual (67%), and diagnosed with stage I or II disease (63%). Breast (40%), prostate (26%) and lung (21%) were the most common cancers. 328 cases (3%) in the sample consisted of HPV-associated cancers. Half of the sample were current or former smokers. Univariate analyses revealed lower hazard ratios (HRs) of a new MRPD among individuals that identified as Asian/Pacific Islander (API) and among older patients ( &gt; 51 years). Higher HRs of MRPDs were found for females; sexual minorities; former and current smokers; those with HPV-associated cancers; and those with later cancer stages (III and IV). These associations were observed in the adjusted multivariate model: APIs (aHR 0.60, 95%CI 0.46-0.65); 51-64 years (aHR 0.83, 95%CI 0.76-0.92); &gt; 65 years (aHR 0.70, 95%CI 0.63-0.78); females (aHR 1.78, 95%CI 1.64-1.94); sexual minority (aHR 1.78, 95%CI 1.40-2.27); former smoker (aHR 1.40, 95%CI 1.30-1.52); current smoker (aHR 1.79, 95%CI 1.60-2.00); HPV-associated tumors (aHR 1.23, 95%CI 1.02-1.49); stage III diagnosis (aHR 1.58, 95%CI 1.34-1.85); stage IV diagnosis (aHR 2.31, 95%CI 1.96-2.73). Conclusions: IBRFs increased the risk of a new MRPD after being diagnosed with cancer. Prior work has associated HPV-positivity with anxiety and depression in patients without a cancer diagnosis. Our findings build on this and show that individuals diagnosed with HPV-associated cancers have a higher risk of developing new MRPDs after their cancer diagnoses. These findings can help identify patients at risk of developing new MRPDs post-cancer diagnosis to engage them in treatment.

Racial/ethnic differences in incidence of squamous cell carcinoma in California.

11139 Background: Squamous cell lung carcinoma is strongly associated with a history of smoking. Typically, no actionable mutations are found, and treatment options are more limited. It is not known if race has any impact on the incidence of squamous cell cancers, especially for Asian ethnicities since most studies combine multiple Asian populations in an Asian/Pacific Islander (API) category. The purpose of this study was to compare the odds of squamous cell carcinoma versus adenocarcinoma in Hispanic, American Indian, Middle Eastern, and 7 Asian ethnicities when compared with both Black and White men and women. Methods: We accessed 211,987 cases of invasive lung cancer with either squamous cell or adenocarcinoma from the California Cancer Registry 2000-2020. Race was categorized as White, African American/Black, Hispanic, American Indian/Alaskan Native, Middle Eastern, Chinese, Japanese, Korean, Filipino, Southeast Asian (SEA), Pacific Islander, or Asian Indian. Separate logistic regression analyses were used to assess the odds of squamous cell versus adenocarcinoma for each race/ethnicity using White and Black as the reference categories. Analyses were conducted separately for males and females and adjusted for age, smoking status, socioeconomic status, marital status, and Charlson Comorbidity Score. Odds Ratios (OR) and 95% confidence intervals (CI) were computed. Results: When compared with White men, American Indian men had increased odds (OR: 1.39; 95% CI: 1.03, 1.88) and Black, Hispanic, Chinese, Filipino, SEA men had decreased odds of squamous cell carcinoma. Japanese women had increased odds (OR: 1.54; 95% CI: 1.15, 2.07) while Black, Hispanic, Middle Eastern, Filipino, and SEA women had decreased odds of squamous cell carcinoma when compared with White women. When compared with Black men, White men, (OR: 1.11; 95% CI: 1.01, 1.24) American Indian, (OR: 1.56; 95% CI: 1.13, 2.13) and Korean (OR: 1.35; 95% CI: 1.05, 1.73) men had increased odds and Chinese, Filipino, and SEA men had decreased odds of squamous cell carcinoma. White, (OR: 1.13; 95% CI: 1.01, 1.28) Japanese, (OR: 1.75; 95% CI: 1.28, 2.39) and Korean (OR: 1.63; 95% CI: 1.09, 2.42) women had increased odds and Southeast Asians had decreased odds when compared with Black women. Conclusions: Some Asian ethnicities have a higher risk for squamous cell lung cancer than both Black and White men and women even after adjusting for smoking. This is not apparent when the Asian ethnicities are classified as API. Examining individual Asian ethnicities is important since they have little to no shared genetic or cultural variables and are grouped together for convenience rather than any scientifically plausible reason.

Recent trends in incidence, survival and mortality of female breast in the US: A Surveillance, Epidemiology, and End Results (SEER) database study 2010-2020.

e23078 Background: We examined epidemiological trends and patient characteristics including age, race, incidence and survival in female breast cancer (BC) using the updated largest population-based cancer registry in the US. Methods: Female patients diagnosed with breast cancer between 2010-2020 were identified in SEER registries. We incorporated SEER 22 registries to calculate incidence, race, disease characteristics and overall survival. Results: Incidence Rate (IR) for BC has been increasing by 0.4%/year and mortality rates (MR) have declined 1.3%/year during 2010-2020 for all patients. 5-&amp;10-year overall survival (OS) has increased by 0.1 and 0.2% respectively. For ages &lt; 50 years,IR increased by 0.9% vs 0.4% for those 65 and above. No statistically significant change in IR was noted for ages 50-64y. For ages &lt; 50 and between 50-64y, MR overall decreased by 1.4%/y each vs by 1.1%/y for those 65+. However, no statistically significant change in MR was noted for women &lt; 50y between 2016-2020. IR increased by 1.6%/year in Asian/Pacific Islanders (API), 1.1%/y in Hispanics (H),0.6% in Blacks (B) and 0.4% in Non-Hispanic White (NHW) and. MR declined 1.5%/y in B, 1.2%/y NHW, 1% H and by 0.3% in API.IR for HR+/HER2- BC increased by 1.9%. No statistically significant change in IR was noted for triple negative or HER2+ only BC. IR for HR+/HER2+ BC increased overall during this time period by 1.4%; however, IR increased by 3.6% between 2010-2016 and decreased by 2.9% after 2016. 5y-OS was 91% in 2015 (CI 90.7-91.3) for all women, improved from 89.7% in 2010 (CI 89.4-90.0). 5yOS was 90.7% vs 91.3% vs 91.0% for &lt; 50, 50-64 and 65+ age groups. When compared to 2010 and 2005, 5yOS was consistently improved across all age groups. 5yOS in B was 82.5% (CI 81.6-83.4) vs 92.1% (CI 91.8-92.5) in NHW. This discrepancy existed across all age groups: for &lt; 50, 50-64 and 65+y, 91.6 vs 92.5 vs 92.1% for W women vs 82.7 vs 82.9 vs 82.0% for their B counterparts. 5yOS for localized, regional and distant disease at diagnosis for all women was 99.2%, 86.7% and 31.5%. 5yOS for B vs W females was 95.9 vs 99.7% localized, 78.3 vs 88% regional and 23.4 vs 33.0% for distant disease. Conclusions: Epidemiological trends show improved OS in BC among all groups. B females and patients with advanced stage have worse outcomes. Greater increase in IR was noted for women &lt; 50 years of age. Greater IR increase was noted in H and API women but decline in MR was smallest in these women. IR for HR/HER2 + BC increased initially followed by a decline. 5r survival in B women was lower compared to NHW across all age groups. 5y survival for B women was worse, irrespective of stage at diagnosis. We hypothesize underlying disease biology may be a potential factor for worse outcome in B women.

Disparities in stage at presentation for disaggregated Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups with breast cancer.

1119 Background: Cancer is the leading cause of death for AANHPI populations, who represent one of the most diverse and fastest-growing racial/ethnic groups in the US. Prior research has shown that AANHPI patients in aggregate have a lower risk of breast cancer than Non-Hispanic White (NHW) peers. However, within-group disparities in stage at presentation remain largely unexplored and are important given disparate access to primary care and cancer screening in certain populations. Methods: Data from 2004 to 2020 were extracted from the National Cancer Database (NCDB) for women newly diagnosed with breast cancer. Patients were disaggregated into AANHPI subgroups based on indigenous history or country of origin. Ordinal logistic regression, adjusting for clinical and sociodemographic factors, was used to calculate adjusted odds ratios (AORs), with higher AORs signifying more advanced stage diagnoses, from Stage 0 to IV. Results: Out of 2,563,180 patients with breast cancer, 83,315 (3.25%) identified as AANHPI. Compared to NHW patients, AANHPI patients were younger (median age, NHW: 63 years vs. AANHPI: 58 years, χ2 P&lt;0.001) and more likely to be uninsured or on Medicaid (NHW: 51% vs. AANHPI: 58%, χ2 P&lt;0.001). The largest AANHPI subgroups were Chinese (n=18,708), Filipino (n=18,429), Indian/Pakistani (n=16,424), Korean (n=6,548), and Vietnamese (n=5,345). Stage 3 or 4 disease was more common among NHW than AANHPI patients (11.3% vs 10.7%, χ2 p&lt;0.001). In aggregate, AANHPI patients were less likely to present with later-stage disease (AOR: 0.88, 95% CI 0.87-0.90, p &lt; 0.001). AANHPI disaggregation revealed that Hawaiian (AOR 1.13, 95% CI 1.07–1.21, p &lt; 0.001), Hmong (AOR 1.86, 95% CI 1.34–2.60, p &lt; 0.001), Laotian (AOR 1.46, 95% CI 1.23–1.74, p &lt; 0.001), and Pacific Islander patients (AOR 1.25, 95% CI 1.16–1.34, p &lt; 0.001) were more likely to present at a more advanced stage relative to NHW patients. Relative to Chinese Americans (the largest AANHPI subgroup), all AANHPI patients were significantly more likely to be diagnosed at a later stage of disease. The largest odds were observed in Hmong (AOR = 2.60, 95% CI 1.87–3.62, p &lt; 0.001), Laotian (AOR = 2.00, 95% CI 1.68–2.39, p &lt; 0.001), Pacific Islander (AOR = 1.71, 95% CI 1.59–1.84, p &lt; 0.001), Hawaiian (AOR = 1.54, 95% CI 1.44–1.65, p &lt; 0.001), and Kampuchean (AOR = 1.42, 95% CI 1.20–1.68, p &lt; 0.001) patients. Conclusions: This disaggregation study finds disparities in the stage of breast cancer at presentation across AANHPI groups, with patients of Hawaiian, Hmong, Laotian, and Pacific Islander descent more likely to be diagnosed at advanced stages when treatments are more intense and cure less likely. Research which considers AANHPI patients as a monolith masks poor outcomes from disparate subgroups that could benefit from targeted, culturally tailored interventions that involve community leaders and leverage cultural norms.

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States.

Genomic analysis of the tumor microenvironment in Asian and Native Hawaiian and Pacific Islander patients with triple negative breast cancer.

e12644 Background: Triple negative breast cancer (TNBC) accounts for approximately 10- 20% of breast cancer cases and has the worst overall survival and prognosis compared to other subtypes. Unlike other subtypes, patients with TNBC are responsive to neoadjuvant therapy. A higher percent of stromal tumor infiltrating lymophocytes (sTILs) in the tumor microenvironment of TNBC correlates with an improved prognosis. Previous studies demonstrate that Native Hawaiians and Pacific Islanders (NHPIs) and Asians have equivocal percent of sTILs. Yet NHPIs have a higher mortality rate at 24.9% compared to Asians at 11%. Our study aims to molecularly characterize the tumor microenvironment in a diverse population of patients with TNBC who received neoadjuvant therapy. Methods: Retrospective chart review was conducted on 12 Asians and 12 NHPI patients with early stage TNBC from 2015 to 2022 from a medical oncology clinic within the Hawai’i Pacific Health system. Patient data collected include age at diagnosis of breast cancer, histology, BMI, clinical stage, sTILs, residual cancer burden, neoadjuvant treatment, and pathologic complete response. Core biopsy samples were processed and analyzed using the nCounter Breast Cancer 360 Panel. Further analysis was obtained using the nSolver Advanced Analysis Module. Results: Patient characteristics are listed in the table. Most patients had the basal-like immunosuppressed TNBC subtype. Among differentially expressed genes between races, 31 genes were statistically significant. NHPIs expressed more IL12RB2 and MYC, and Asians expressed more FGFR4 and MLPH. Among responders compared to non-responders, 5 genes were statistically significant. Responders expressed more STC1 and PTGER3, and non-responders expressed more CRAYAB, TMPRSS2, and CHAD. Among old and young patients, 132 genes were statistically significant. Older patients expressed more FUT3 and CKMT1, and younger patients expressed more MMP7 and MIA. Conclusions: In this pilot study, the molecular and genetic differences suggest that the tumor microenvironment may play a role in treatment outcomes between NHPIs and Asians. Further analysis will be conducted to determine the differences in immune cell infiltration. [Table: see text]