non-Hispanic Asian/Pacific Islander Research Articles

Racial Disparities in the Incidence and Survival Outcomes in Diffuse Large B-Cell Lymphoma in Adolescents and Young Adults

Background Diffuse Large B-Cell Lymphoma (DLBCL) is an aggressive subtype of non-Hodgkin lymphoma, and generally occurs most frequently in Whites, with a median age of 64 years 1. Adolescent and Young Adult (AYA) cancer is defined as cancer in individuals 15 to 39 years old 2. There is paucity of data on racial and ethnic disparities in the incidence of DLBCL in AYA. We aim to determine the influence of race on the incidence and survival outcomes of DLBCL in the AYA cohort. Methods Data from the Surveillance, Epidemiology, and End Results (SEER) 17 Research Plus database program was utilized to obtain the annual percentage change (APC) in incidence of DLBCL from 2000 - 2020 for patients aged 15 - 39 years (AYA group). Patient characteristics were expressed in proportions (%). The Kaplan Meier method was used to determine overall survival (OS) and cancer-specific survival (CSS). Cox regression was performed to determine predictors of survival. A p-value ≤0.05 was considered statistically significant. Results We identified a total of 8735 AYA patients diagnosed with DLBCL (see Table). The proportion of patients with DLBCL decreased the most in Non Hispanic Blacks (NHB, 45% vs 55%, p-value ≤0.001) and Non-Hispanic Whites (NHW, 45% vs 55%, p-value ≤0.001), followed by Non-Hispanic American Indian/Alaska Natives (NHAIAN, 48% vs 52%, p-value ≤0.001). No change was noted in the Hispanic (all races) group (50% vs 50%, p-value ≤0.001). The Non-Hispanic Asian/Pacific Islander (NHAPI) group showed the highest proportion of patients with DLBCL (58%) in 2011-2020 compared to 2000-2010 (42%), p-value ≤0.001. Over the study period (2000 - 2020), there was a significant decrease in the yearly incidence of DLBCL in the overall AYA cohort (APC: -0.5%, p <0.05). This reduction was most pronounced in NHB (APC: -1.4%, p-value ≤0.001), followed by Hispanics, all races (APC: -0.65%, p-value ≤0.001) and NHW (-0.57%, p ≤0.04). However, there was a significant increase in the incidence of DLBCL in NHAPI (APC: 1.88%, p-value ≤0.001) during the same time period. OS for NHAIAN was 58 months (95% CI: 21-147, p ≤0.001), 63 months (95% CI: 19-139, p-value ≤0.001) for NHAPI; 63 months (95% CI: 13-142, p ≤0.001) for NHB; 58 months (95% CI 14-134, p≤0.001) for Hispanics, all races; and 98 months (95% CI: 31-172, p≤0.001) for NHW. The 5 and 10-year CSS were 86.5% and 85.4% for NHW (p-value ≤0.001); 85.4% and 84.4% for NHAPI (p ≤0.001); 81.3% and 80.3% for Hispanics, all races (p ≤0.001); 68.1% and 68.1% (p ≤0.001) for NHAIAN; and 71.9% and 69.4% for NHB (p-value ≤0.001) (see Figure).In the multivariable model, NHB (HR = 1.91, 95%, CI: 1.70-2.15, p ≤0.001), NHAIAN (HR = 2.09, 95% CI: 1.29-3.38, p≤0.003) and Hispanic, all races (HR 1.35, 95% CI: 1.20-1.53, p≤0.001) were associated with reduced odds of survival, compared to NHW. Conclusion There is a significant racial/ethnic disparity in the incidence and outcomes of DLBCL among AYA patients. Increase in incidence of DLBCL was observed only in NHAPI. Despite the significant improvement in the incidence of DLBCL in NHB over the years, odds of survival remain poorer than other racial/ethnic groups, except NHAIAN. More studies are needed to explore the reasons for these racial differences and more concerted efforts are needed to improve outcomes among AYA patients.

Racial Disparities in Survival Outcomes of Patients With Serous Epithelial Ovarian Cancer: A Retrospective Cohort Analysis.

To identify racial disparities in five-year survival rates in women affected by serous epithelial ovarian carcinoma in the United States (US). This retrospective cohort study analyzed data from the 2010 to 2016 Surveillance, Epidemiology, and End Results (SEER) program database. Women with a primary malignancy of serous epithelial ovarian carcinoma, using International Classification of Diseases for Oncology (ICD-O) Topography Coding and ICD-O-3 Histology Coding, were included in this study. Race and ethnicity were combined into the following groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic Other (NHO), and Hispanics. Cancer-specific survival was measured at five years post-diagnosis. A comparison of baseline characteristics was assessed using Chi-squared tests. Unadjusted and adjusted Cox regression models were used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI). From 2010 to 2016, there were 9,630 women with a primary diagnosis of serous ovarian carcinoma identified in the SEER database. A higher proportion of Asian/PI women (90.7%) were diagnosed with high-grade malignancy (poorly differentiated/undifferentiated) compared to NHW women (85.4%). NHB women (9.7%) were less likely to undergo surgery when compared to NHW women (6.7%). Hispanic women had the highest proportion of uninsured women (5.9%), while NHW and NHAPI had the lowest (2.2% each). A higher proportion of NHB (74.2%) and Asian/PI (71.3%) women presented with the distant disease compared to NHW women (70.2%). After adjustment for age, insurance, marital status, stage, metastases, and surgical resection, NHB women had the highest hazard of death within five years compared to NHW women (adjusted (adj) HR 1.22, 95% CI 1.09-1.36, p<0.001). Hispanic women also had lower five-year survival probabilities compared to NHW women (adj HR 1.21, 95% CI 1.12-1.30, p<0.001). Patients undergoing surgery had significantly increased survival probability compared to those who did not (p<0.001). As expected, women with Grade III and Grade IV disease both had significantly lower five-year survival probabilities compared to Grade I (p<0.001). This study reveals that there is an association between race and overall survival in patients with serous ovarian carcinoma, with NHB and Hispanic women having the highest hazards of death compared to NHW women. This adds to the existing body of literature as survival outcomes in Hispanic patients relative to NHW patients are not well documented. Because of the potential interplay between overall survival and several factors including race, future studies should aim to investigate other socioeconomic factors that may be impacting survival.

Abstract C119: Rising incidence and racial disparities of early-onset endometrial cancer in the United States, 1995-2018

Abstract BACKGROUND: Endometrial cancer (EC) is the most common gynecologic cancer and the fourth most common cancer among women in the United States (US). Although early-onset endometrial cancer (EOEC, diagnosed under age 50) is relatively uncommon, several studies have reported the incidence of EOEC has been increasing in recent decades. Because few studies have examined differences in incidence trends across race/ethnicity between EOEC and late-onset endometrial cancer (LOEC, diagnosed at age 50 or older), we compared the incidence trends between EOEC and LOEC in the US by race/ethnicity across two decades. METHODS: We used the CiNA Analytic File, 1995-2018, Public Use, obtained from the North American Association of Central Cancer Registries (NAACCR) and identified 930,176 invasive endometrial cancer cases (ICD-O-3 site code C54.1, excluding histology codes 9050-9055, 9140, and 9590-9992), of which 12.6% were EOEC and 87.4% LOEC. We examined the characteristics of these cases including race/ethnicity, year of diagnosis, tumor stage and grade by EOEC and LOEC status. We calculated the yearly race/ethnicity-specific age-adjusted incidence rates (AAIR) and the average annual percent change (AAPC) in the AAIRs for EOEC and LOEC respectively. RESULTS: Compared with LOEC cases, women with EOEC were less likely to be non-Hispanic (NH) White, more likely to be Hispanic or NH Asian/Pacific Islander (API), and less likely to have advanced stage or poorly differentiated grade. The AAIRs were highest in NH Whites in 1995 for both EOEC and LOEC. By 2018, the highest AAIR was found in Hispanics for EOEC and in NH Blacks for LOEC, resulting from faster increases in EC risk among the non-white groups. AAIRs for EOEC and LOEC increased over the study period, with the overall AAPC being three times as high for EOEC as LOEC (AAPC 1.72 vs. 0.57). For EOEC, the largest increases were observed in NH Blacks (AAPC=3.52) followed by Hispanics (AAPC=2.77) and NH API (AAPC=2.06). For LOEC, the largest increases were observed in NH APIs (AAPC=2.42) followed by NH Blacks (AAPC=2.28) and Hispanics (AAPC=1.71). For both EOEC and LOEC, the AAPCs were highest in NH Blacks and lowest in NH Whites. CONCLUSIONS: The faster increases in EOEC incidence among NH Black, Hispanic, and NH API women likely reflect racial/ethnic differences in the prevalence and trends of endometrial cancer risk factors. This indicates that these higher-risk populations might benefit from targeted surveillance and interventions. Future studies should evaluate whether these differences across race/ethnicity are attributable to specific tumor characteristics, biomarkers, or other sociodemographic factors. Citation Format: Talar S. Habeshian, Lihua Liu, Juan-Juan Zhang, Margaret Du, Immaculata De Vivo, Veronica W. Setiawan. Rising incidence and racial disparities of early-onset endometrial cancer in the United States, 1995-2018 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C119.

The Association between Race/Ethnicity and Cancer Stage at Diagnosis of Bone Malignancies: A Retrospective Cohort Study

Limited data exists analyzing disparities in diagnosis regarding primary bone neoplasms (PBN). The objective of our study was to determine if there is an association between race/ethnicity and advanced stage of diagnosis of PBN. This population-based retrospective cohort study included patient demographic and health information extracted from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER). The main exposure variable was race/ethnicity categorized as non-Hispanic white (NH-W), non-Hispanic black (NH-B), non-Hispanic Asian Pacific Islander (NH-API), and Hispanic. The main outcome variable was advanced stage at diagnosis. Age, sex, tumor grade, type of bone cancer, decade, and geographic location were co-variates. Unadjusted and adjusted logistic regression analyses were conducted calculating odds ratios (OR) and corresponding 95% confidence intervals. Race/ethnicity was not statistically significantly associated with advanced-stage disease. Adjusted OR for NH-B was 0.94 (95% CI: 0.78-1.38), for NH-API 1.07 (95% CI: 0.86-1.33) and for Hispanic 1.03 (95% CI: 0.85-1.25). The lack of association between race and advanced stage of disease could be due to high availability and low cost for initial management of bone malignancies though plain radiographs. Future studies may include socioeconomic status and insurance coverage as covariates in the analysis.

Trends in gestational diabetes mellitus among nulliparous pregnant individuals with singleton live births in the United States between 2011 to 2019: an age-period-cohort analysis

The rate of gestational diabetes mellitus has increased over the past decade. An age, period, and cohort epidemiologic analysis can be used to understand how and why disease trends have changed over time. This study aimed to estimate the associations of age (at delivery), period (delivery year), and cohort (birth year) of the pregnant individual with trends in the incidence of gestational diabetes mellitus in the United States. We conducted an age, period, and cohort analysis of nulliparous pregnant adults aged 18 to 44 years with singleton live births from the National Vital Statistics System from 2011 to 2019. Generalized linear mixed models were used to calculate the adjusted rate ratios for the incidence of gestational diabetes mellitus for each 3-year maternal age span, period, and cohort group compared with the reference group for each. We repeated the analyses with stratification according to self-reported racial and ethnic group (non-Hispanic Asian-Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic White) because of differences in the incidence of and risk factors for gestational diabetes mellitus by race and ethnicity. Among 11,897,766 pregnant individuals, 5.2% had gestational diabetes mellitus. The incidence of gestational diabetes mellitus was higher with increasing 3-year maternal age span, among those in the more recent delivery period, and among the younger birth cohort. For example, individuals aged 42 to 44 years at delivery had a 5-fold higher risk for gestational diabetes mellitus than those aged 18 to 20 years (adjusted rate ratio, 5.57; 95% confidence interval, 5.43-5.72) after adjusting for cohort and period. Individuals who delivered between 2017 and 2019 were at higher risk for gestational diabetes mellitus than those who delivered between 2011 and 2013 (adjusted rate ratio, 1.24; 95% confidence interval, 1.23-1.25) after adjusting for age and cohort. Individuals born between 1999 and 2001 had a 3-fold higher risk for gestational diabetes mellitus than those born between 1969 and 1971 (adjusted rate ratio, 3.12; 95% confidence interval, 2.87-3.39) after adjusting for age and period. Similar age, period, and cohort effects were observed for the assessed racial and ethnic groups, with the greatest period effects observed among Asian and Pacific Islander individuals. Period and birth cohort effects have contributed to the rising incidence of gestational diabetes mellitus in the United States from 2011 to 2019.

The rising incidence of sex cord stromal ovarian tumors in the US: Who is most at risk? (442)

The rising incidence of sex cord stromal ovarian tumors in the US: Who is most at risk? (442)

Abstract 042: Trends In Hypertensive Disorders Of Pregnancy Among Nulliparous Individuals With Singleton Live Births In The United States: An Age-period-cohort Analysis Between 1995-2019

Introduction: Incidence of hypertensive disorders of pregnancy (HDP) has increased concurrently with maternal age at first birth. To better understand the contributions of age, delivery year (period), and maternal birth year (birth cohort) to HDP rates, we performed an age-period-cohort analysis. Methods: We included data from the National Center for Health Statistics for nulliparous individuals without pre-pregnancy hypertension who were 15-44 years with singleton live births from 1995-2019. We defined HDP as gestational hypertension, preeclampsia or eclampsia. We determined age effects by calculating HDP incidence adjusted separately for period and cohort in each 5-year age group. Period and cohort effects were quantified as rate ratios (RR) comparing age-adjusted HDP incidence to the median period (2005-2009) and cohort (1980-1984), respectively. Age, period, and cohort effects were summarized as the age-standardized estimated annual percent change (EAPC) in HDP rates adjusted for cohort and stratified by self-reported maternal race and ethnicity group (Hispanic, non-Hispanic American Indian/Alaskan Native [AIAN], non-Hispanic Asian-Pacific Islander [API], non-Hispanic Black [NHB], non-Hispanic White [NHW]). Results: Of 38,141,561 individuals included, 0.8% were AIAN, 6.5% API, 20.2% Hispanic, 13.9% NHB, and 57.8% NHW. Mean maternal age increased from 1995-2019 (24.5-26.9). Age, period and cohort were each significantly associated with HDP rates overall and in each race and ethnicity group. Incidence was higher with older maternal age. Age-standardized incidence increased from 1995-2019 (EAPC 2.1%/year [2.1-2.2]). RR of HDP in pregnant individuals born 2000-2004 versus 1980-1984 was 1.5 (1.4-1.5). Differences in RRs among racial and ethnic groups were observed with the largest cohort effects among API and NHB individuals born 2000-2004. ( FIGURE ). Conclusions: More recent generations have experienced substantially higher rates of HDP, even with adjustment for maternal age and delivery year.

Abstract P3-14-05: Racial/ethnic disparities in cancer mortality after a second breast cancer

Abstract Background: Eighteen percent of breast cancer survivors will develop a second cancer within 25 years of diagnosis, of which breast cancer is the most common type. We have previously reported a higher cancer mortality among survivors who had a second cancer compared to a first cancer. In this study, we examined whether the increased cancer mortality from a second breast cancer differs by race/ethnicity. Method: A prospective cohort study was conducted among breast cancer survivors who developed a second breast cancer using data collected from the Surveillance, Epidemiology, and End Results (SEER) 18 database between 2000 and 2016. Hazard ratio (HR) and 95% confidence interval (CI) for cancer mortality after second breast cancer were estimated from Cox proportional hazard regression, comparing Non-Hispanic Black (NHB), Non-Hispanic American Indian/Alaska Native (NHAIAN), Non-Hispanic Asian/Pacific Islander (NHAPI), and Hispanic women to Non-Hispanic White (NHW) women. Models were adjusted for age at diagnosis, year of diagnosis, tumor stage, tumor grade, estrogen receptor (ER) status, and treatments (surgery, radiotherapy, and chemotherapy) of the second breast cancer. Analyses were also stratified by second cancer ER status, tumor stage, age at diagnosis (&amp;lt;50, 50-75, and ≥75 years), and time since first breast cancer diagnosis (≤5 and &amp;gt;5 years). In a subgroup of women diagnosed of second cancer after 2010 (N=8,224), we also conducted the analysis stratified by breast cancer molecular subtype [luminal A, triple-negative, and human epidermal growth factor receptor 2 (HER2)-positive]. Results: There were 14,392 breast cancer survivors diagnosed with a second breast cancer, including 9,928 NHW, 1,975 NHB, 70 NHAIAN, 988 NHAPI, and 1,431 Hispanic during the study period. The median age at diagnosis of the second cancer ranged from 57 to 66 years and the median follow-up time from diagnosis to cancer death ranged from 52 to 62 months across racial and ethnic groups. Cancer mortality was increased among NHB (HR: 1.28, 95%CI: 1.15-1.43) and Hispanic survivors (HR: 1.17, 95%CI: 1.03-1.33) compared to NHW. There was no increased cancer mortality among NHAIAN (HR: 1.07, 95%CI: 0.61-1.90) and NHAPI survivors (HR: 0.94, 95%CI: 0.80-1.12). The increased cancer mortality in NHB was observed irrespective of second cancer ER status, tumor stage, age at diagnosis, and time since first breast cancer diagnosis. Increased cancer mortality in NHB was also observed for luminal A (HR: 1.26, 95%CI: 1.11-1.44) and triple-negative subtypes (HR: 1.42, 95%CI: 1.10-1.83), but not for HER2-positive (HR: 1.19, 95%CI: 0.88-1.60) disease. For Hispanic patients, increased cancer mortality was observed in women with ER-positive disease, regional stage disease, cancer diagnosed &amp;lt;50 years of age, and cancer developed after 5 years. Conclusion: Racial/ethnic disparities in cancer mortality are present even among NHB and Hispanic breast cancer survivors who developed a second breast cancer. Studies are needed to understand the drivers of these disparities and to test preventive strategies to mitigate them. Citation Format: Zhengyi Deng, Miranda R Jones, Mei-Cheng Wang, Kala Visvanathan. Racial/ethnic disparities in cancer mortality after a second breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-05.

Racial disparities in women with serous epithelial ovarian cancer: a Surveillance, Epidemiology, and End Results (SEER) survival analysis

<h3>Objectives:</h3> Serous epithelial ovarian carcinoma (SOC) is the most lethal form of gynecological malignancy in the United States (US), with high-grade SOC accounting for up to 80% of cancer-specific deaths. Existing literature has identified socioeconomic barriers in gynecologic malignancies. However, patterns of racial disparity have not been fully examined. This study aims to identify racial and ethnic disparities in five-year survival rates in women affected by SOC in the US. <h3>Methods:</h3> This retrospective cohort study analyzed data from the 2010-2016 Surveillance, Epidemiology, and End Results (SEER) program database. Women with a primary malignancy of serous epithelial ovarian carcinoma, using ICD-O Topography Coding and ICD-O-3 Histology coding, were included in this study. Race and ethnicity were combined into the following groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic Other (NHO), and Hispanics. Cancer-specific survival was measured at five years post-diagnosis. Comparison of baseline characteristics were assessed using Chi-square tests (Table 1). Unadjusted and adjusted Cox regression models were used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI). <h3>Results:</h3> From 2010-2016, there were 9,630 women with a primary diagnosis of SOC. A higher proportion of Asian/Pacific Islander women (90.7%) were diagnosed with high grade malignancy (poorly differentiated/undifferentiated) compared to NHW women (85.4%). NHB women (9.7%) were less likely to undergo surgery when compared to NHW women (6.7%). Hispanic women had the highest proportion of uninsured women (5.9%), when compared to other racial groups. A higher proportion of NHB (74.2%) and Asian/PI (71.3%) women presented with distant disease compared to NHW women (70.2%). After adjustment for age, insurance, marital status, stage, metastases, and surgical resection, NHB women had the highest hazard of death within five years compared to NHW women (adjusted (adj) HR 1.22 95% CI 1.09-1.36, p<0.001). Additionally, Hispanic had lower five-year survival probabilities compared to NHW women (adj HR 1.21 95% CI 1.12-1.30, p<0.001). Patients undergoing surgery had significantly increased survival probability compared to those who did not (p<0.001). As expected, women with Grade III and Grade IV disease both had significantly lower five-year survival probabilities compared to Grade I (p<0.001). <h3>Conclusions:</h3> This study reveals that there are racial and ethnic disparities in five-year survival in patients with serous ovarian carcinoma, with NHB and Hispanic women having the highest hazards of death compared to NHW women. The racially and ethnically disparate outcomes of ovarian cancer are likely due to an interplay between several factors including unmeasured social determinants of health, and therefore future studies should aim to investigate other socioeconomic factors that may be impacting survival.

Racial disparities in women with triple-negative breast cancer: a 2010-2016 SEER-based survival analysis

Objectives: Serous epithelial ovarian carcinoma (SOC) is the most lethal form of gynecological malignancy in the United States (US), with high-grade SOC accounting for up to 80% of cancer-specific deaths. Existing literature has identified socioeconomic barriers in gynecologic malignancies. However, patterns of racial disparity have not been fully examined. This study aims to identify racial and ethnic disparities in five-year survival rates in women affected by SOC in the US. Methods: This retrospective cohort study analyzed data from the 2010-2016 Surveillance, Epidemiology, and End Results (SEER) program database. Women with a primary malignancy of serous epithelial ovarian carcinoma, using ICD-O Topography Coding and ICD-O-3 Histology coding, were included in this study. Race and ethnicity were combined into the following groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic Other (NHO), and Hispanics. Cancer-specific survival was measured at five years post-diagnosis. Comparison of baseline characteristics were assessed using Chi-square tests (Table 1). Unadjusted and adjusted Cox regression models were used to calculate hazard ratios (HR) and corresponding 95% confidence intervals (CI). Download : Download high-res image (227KB) Download : Download full-size image Results: From 2010-2016, there were 9,630 women with a primary diagnosis of SOC. A higher proportion of Asian/Pacific Islander women (90.7%) were diagnosed with high grade malignancy (poorly differentiated/undifferentiated) compared to NHW women (85.4%). NHB women (9.7%) were less likely to undergo surgery when compared to NHW women (6.7%). Hispanic women had the highest proportion of uninsured women (5.9%), when compared to other racial groups. A higher proportion of NHB (74.2%) and Asian/PI (71.3%) women presented with distant disease compared to NHW women (70.2%). After adjustment for age, insurance, marital status, stage, metastases, and surgical resection, NHB women had the highest hazard of death within five years compared to NHW women (adjusted (adj) HR 1.22 95% CI 1.09-1.36, p Conclusions: This study reveals that there are racial and ethnic disparities in five-year survival in patients with serous ovarian carcinoma, with NHB and Hispanic women having the highest hazards of death compared to NHW women. The racially and ethnically disparate outcomes of ovarian cancer are likely due to an interplay between several factors including unmeasured social determinants of health, and therefore future studies should aim to investigate other socioeconomic factors that may be impacting survival.

Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma—A SEER Registry Analysis

Simple SummaryThe results of this study show the effects of socio-economic determinants, such as higher income levels, high school education, private insurance, and married marital status, have favorable survival in patients with young-onset colorectal cancer (YoCRC). Moreover, most of the positive social factors are often interrelated. The inclusion of these factors could further prognosticate and help with healthcare resource allocation for successful interventions through public health measures. Colorectal cancer awareness, knowledge, and even utilization of medical services would differ with the education and health literacy.Introduction: We aimed to assess the impact of socio-economic determinants of health (SEDH) on survival disparities within and between the ethnic groups of young-onset (<50 years age) colorectal adenocarcinoma patients. Patients and Methods: Surveillance, epidemiology, and end results (SEER) registry was used to identify colorectal adenocarcinoma patients aged between 25–49 years from 2012 and 2016. Survival analysis was performed using the Kaplan–Meir method. Cox proportional hazards model was used to determine the hazard effect of SEDH. American community survey (ACS) data 2012–2016 were used to analyze the impact of high school education, immigration status, poverty, household income, employment, marital status, and insurance type. Results: A total of 17,145 young-onset colorectal adenocarcinoma patients were studied. Hispanic (H) = 2874, Non-Hispanic American Indian/Alaskan Native (NHAIAN) = 164, Non-Hispanic Asian Pacific Islander (NHAPI) = 1676, Non-Hispanic black (NHB) = 2305, Non-Hispanic white (NHW) = 10,126. Overall cancer-specific survival was, at 5 years, 69 m. NHB (65.58 m) and NHAIAN (65.67 m) experienced worse survival compared with NHW (70.11 m), NHAPI (68.7), and H (68.31). High school education conferred improved cancer-specific survival significantly with NHAPI, NHB, and NHW but not with H and NHAIAN. Poverty lowered and high school education improved cancer-specific survival (CSS) in NHB, NHW, and NHAPI. Unemployment was associated with lowered CSS in H and NAPI. Lower income below the median negatively impacted survival among H, NHAPI NHB, and NHW. Recent immigration within the last 12 months lowered CSS survival in NHW. Commercial health insurance compared with government insurance conferred improved CSS in all groups. Conclusions: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors conferring favorable survival found on multivariate analysis.

Increased Incidence of Philadelphia Negative B-Cell Acute Lymphoblastic Leukemia Among Adults of Hispanic Ethnicity: A Population Based Study

Introduction:Previous population-based studies in pediatric acute lymphoid leukemia (ALL) have identified racial and ethnic differences in incident childhood ALL (Med Pediatr Oncol 2002;39:554), but the degree to which these disparities persist among adult ALL patients, who have distinct differences in the molecular subtypes of ALL compared to children, is less clear. Larger studies that look across broad populations of patients are needed to assess these findings in adult ALL. We therefore used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to characterize the incidence of distinct subtypes of ALL in adults, to evaluate whether differences in racial or ethnic incidence rates are seen in the adult population and relate to molecular subtypes of disease.Methods:The 1973-2014 SEER-18 database was used to identify adults, age 20 years or older, diagnosed with lymphoid leukemia between 2000 and 2014. We included only patients with documented race/ethnicity and known age at diagnosis. Leukemia subtypes were defined by the third edition of the Internal Classification of Diseases for Oncology (ICD-O-3) and stratified by cell lineage and BCR-ABL mutation status. BCR-ABL mutation status was added to SEER in 2010 so analysis of these subgroups includes only patients diagnosed 2010-2014. Analysis was carried out comparing ethnicity, Hispanic (H) vs. non- Hispanic (NH), as well as race/ethnicity, non-Hispanic White (NHW) vs. Hispanic White (HW), non-Hispanic Black (NHB) or non-Hispanic Asian-Pacific Islander (NHAPI). Age-adjusted incidence rates (IRs) per 100,000 person-years were calculated using the Rate Session in SEER*Stat. Incidence rate ratios (IRR) were calculated using STATA software. Two-sided p-values were calculated using the mid-p test.Results:An overall higher incidence of ALL was present among patients of Hispanic ethnicity as compared to non-Hispanic (IR 1.59 vs. 1.08, IRR 1.47 p<0.001). The highest rates of ALL occurred in HW versus NHW, NHB, NHAPI (IR 1.613 HW vs. 0.994 NHW, IRR 1.623 p<0.001). The lowest rates occurred in NHB and NHAPI (IR 0.871 NHB and 0.817 NHAPI, IRR .876 and .822 respectively vs. NHW, p<0.001). The higher incident ALL rate among HW appeared to be explained by rates of B-ALL (IR 1.094 HW vs. 0.479 NHW, IRR 2.284 p <0.001). Further exploration, based on molecular subtype, revealed that there was no difference in incidence of BCR-ABL mutated B-cell ALL based on ethnicity (IR 0.066 H vs. 0.071 NH, IRR 0.935 p=0.706). There was, however, an increased incidence of B-cell ALL without a reported BCR-ABL mutation among patients of Hispanic ethnicity (IR 1.392 H vs. 0.695 NH, IRR 2.004 p<0.001). T-ALL was least prevalent among HW and there was no difference in incidence of mixed phenotype leukemia. NHB patients has significantly lower rates of ALL overall, however they had a higher age-adjusted incidence of T-cell ALL (IR 0.352 NHB vs. 0.211 NHW, IRR 1.665 p<0.001).Conclusions:In children, published data suggests an overall increased incidence of ALL among patients of Hispanic ethnicity and a decreased incidence among patients of Black race. Our analysis of SEER data from 2000-2014 shows that these patterns persist among adult patients. Interestingly, in this large, population-based study, we found that the higher rates of ALL among Hispanic populations are largely related to a higher incidence of Ph-negative B-cell ALL, a pattern that persists across all ages (figure 1). We also found an overall decreased rate among NHB patients, despite an increase in T-cell ALL. This is also consistent with findings seen in childhood ALL. The specific trends with Ph-negative B-cell ALL have not been previously described, likely due to limited availability of molecular data until this point. In this study, we found no difference in incidence rates of Ph-positive ALL in Hispanic vs. non-Hispanic populations across all age groupings. Our findings suggest that some underlying mechanism may contribute to higher rates of Ph-negative ALL in this population. Previously hypothesized explanations for this difference include susceptibility genes (ARID5B, PIP4K2A) which may be enriched in certain populations, environmental toxins or chemicals, viruses or other environmental factors. Whether some or most of these factors would account for the approximately double incidence of Ph-negative B-cell ALL across all ages remains unclear and requires further study. [Display omitted] DisclosuresFathi:Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Medimmune: Consultancy, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Juno: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Pfizer: Honoraria; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Brunner:Celgene: Research Funding; Takeda: Research Funding.

Race/ethnicity and advanced stage of renal cell carcinoma in adults: results from surveillance, epidemiology, and end results program 2007-2015.

Non-Hispanic Blacks were shown to have an earlier stage of renal cell carcinoma (RCC) at diagnosis compared to non-Hispanic Whites. It is less clear whether disparities in RCC staging occurs for other minority races/ethnicities. We aimed to assess the association between racial/ethnic minorities and stage at diagnosis of RCC, and test for potential effect modification by histological subtype. Sourced from the Surveillance, Epidemiology and End Results (SEER) database, patients ≥20 years diagnosed with RCC from 2007 to 2015 were included (n = 37 493). Logistic regression analyses were performed to assess the independent association between race/ethnicity [non-Hispanic White, non-Hispanic Black, non-Hispanic Asian Pacific Islander, non-Hispanic American Indian/Alaskan Native (AI/AN) and Hispanic] and advanced RCC stage at diagnosis (i.e. regional spread or distant metastasis). Interaction terms were tested and stratified regression was performed accordingly. Twenty-eight percent of patients had advanced RCC stage at diagnosis. After adjusting for age, gender, year of diagnosis, histological subtype and insurance status, compared to non-Hispanic Whites, non-Hispanic Blacks had lower odds of advanced stage at diagnosis [odds ratio (OR) = 0.79; 95% confidence interval (CI) = 0.72-0.87 for clear cell; OR = 0.48; CI = 0.30-0.78 for chromophobe and OR = 0.26; CI = 0.10-0.35 for other subtypes]. Higher odds of advanced stage at diagnosis were found for non-Hispanic AI/AN in clear cell (OR = 1.27; CI = 1.04-1.55) and for Hispanics in papillary subtypes (OR = 1.58; CI = 1.07-2.33). Racial disparities in the RCC stage at diagnosis varied according to histological subtype. Further investigation on the racial disparities reported is warranted to optimize detection and ultimately improve the prognosis of patients with RCC.

Racial/Ethnic Disparities in Prostate Cancer Incidence, Distant Stage Diagnosis, and Mortality by U.S. Census Region and Age Group, 2012-2015.

We sought to characterize recent prostate cancer incidence, distant stage diagnosis, and mortality rates by region, race/ethnicity, and age group. In SEER*Stat, we examined age-specific and age-adjusted prostate cancer incidence, distant stage diagnosis, and mortality rates by race/ethnicity, census region, and age group. Incidence and mortality analyses included men diagnosed with (n = 723,269) and dying of (n = 112,116) prostate cancer between 2012 and 2015. Non-Hispanic black (NHB) and non-Hispanic Asian/Pacific Islander (NHAPI) men had the highest and lowest rates, respectively, for each indicator across regions and age groups. Hispanic men had lower incidence and mortality rates than non-Hispanic white (NHW) men in all regions except the Northeast where they had higher incidence [RR, 1.16; 95% confidence interval (CI), 1.14-1.19] and similar mortality. Hispanics had higher distant stage rates in the Northeast (RR, 1.18; 95% CI, 1.08-1.28) and South (RR, 1.22; 95% CI, 1.15-1.30), but similar rates in other regions. Non-Hispanic American Indian/Alaskan Native (NHAIAN) men had higher distant stage rates than NHWs in the West (RR, 1.38; 95% CI, 1.15-1.65). NHBs and Hispanics had higher distant stage rates than NHWs among those aged 55 to 69 years (RR, 2.91; 95% CI, 2.81-3.02 and 1.24; 95% CI, 1.18-1.31, respectively), despite lower overall incidence for Hispanics in this age group. For Hispanic and NHAIAN men, prostate cancer indicators varied by region, while NHB and NHAPI men consistently had the highest and lowest rates, respectively, across regions. Regional and age group differences in prostate cancer indicators between populations may improve understanding of prostate cancer risk and help inform screening decisions.

Abstract C085: Racial/ethnic disparities in pancreatic cancer incidence rates and temporal trends in California (1988-2015)

Abstract Background: Pancreatic cancer is a leading cause of cancer death in the United States. Racial/ethnic disparities in pancreatic cancer incidence exist, with African Americans experiencing the highest incidence. Little is known about incidence and temporal trends in other minorities, especially in Asian Americans, heterogeneous populations that are the fastest-growing minority in US. To better understand pancreatic cancer burden, we examined pancreatic cancer incidence patterns and temporal trends among detailed racial/ethnic populations, including Asian-American subgroups. Methods: We identified a total of 97,665 invasive pancreatic cancer cases (ICD-O-3: C25.0-C25.9) using the California Cancer Registry diagnoses between 1988 and 2015. Cases were grouped into mutually exclusive major racial/ethnic groups of non-Hispanic (NH) white, NH black, Hispanic, NH Asian/Pacific Islander (API), and NH American Indian/Alaska Native (AIAN). Asians were further identified by ethnicity of Chinese, Filipino, Japanese, Korean, Vietnamese, other Southeast Asian, and South Asian. Age-adjusted incidence rates (AAIRs per 100,000) by race/ethnicity and time period were calculated. The average annual percent changes (AAPC) in incidence rates between 1988 and 2015 were estimated using Joinpoint Regression. Results: The AAIRs of pancreatic cancer varied significantly across the aggregated racial/ethnic groups. The AAIRs ranged from the highest of 16.0 (95% CI: 15.6 to 16.4) in NH blacks to 11.5 (95% CI: 11.5 to 11.6) in NH whites, 10.7 (95% CI: 10.5 to 10.8) in Hispanics, 9.2 (95% CI: 9.0 to 9.4) in NH APIs, and to the lowest of 8.0 (95% CI: 7.2 to 8.9) in NH AIAN. Despite the relatively low rate in the NH APIs, the rates across Asian subgroups varied significantly, with rates as high as NH whites observed in Japanese (AAIR: 11.5; 95% CI: 10.9 to 12.1) and Korean (AAIR: 11.0; 95% CI: 10.3 to 11.7) to the low rate in South Asians (AAIR: 6.6; 95% CI: 5.9 to 7.4). A small but significant decline in pancreatic cancer incidence rates was observed among NH blacks (AAPC: -0.5; 95% CI: -0.8 to -0.2). NH AIANs experienced the most sizable and significant surge in pancreatic cancer incidence (AAPC: 4.5; 95% CI: 2.4 to 6.6), followed by South Asians (AAPC: 2.4; 95% CI: 0.3 to 4.5), Koreans (AAPC: 1.6; 95% CI: 0.5 to 2.7), and NH whites (AAPC: 0.4; 95% CI: 0.2 to 0.6). Conclusions: Our findings provide the most updated trends in pancreatic cancer incidence across multiple and disaggregated racial/ethnic groups in California. We showed significant heterogeneity of pancreatic cancer incidence in Asian Americans, with high-risk Japanese and Korean populations. These results fill a gap regarding pancreatic cancer burden in Asian Americans and underscore the importance of disaggregating ethnic populations in cancer research. Citation Format: Lihua Liu, Juanjuan Zhang, Dennis Deapen, Mariana Stern, Andrea Sipin, Veronica Wendy Setiawan. Racial/ethnic disparities in pancreatic cancer incidence rates and temporal trends in California (1988-2015) [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C085.

1489-P: Racial/Ethnic Disparities in Deaths Due to Diabetes, Diabetes Ketoacidosis, and Diabetic Coma among Those Aged 1-44 Years: 1999-2017, United States

Although previous studies have reported disparities in diabetes mortality by race/ethnicity, little is known about deaths due to diabetes, diabetes ketoacidosis (DKA) or diabetic coma by race/ethnicity among the younger population in the U.S. We used National Vital Statistics System data for individuals aged 1-44 years from 1999 to 2017 filed in all 50 states and the District of Columbia obtained from CDC Wonder (wonder.cdc.gov). Diabetes-related deaths were based on any listed ICD-10 codes E10-E14. DKA or diabetic coma deaths were based on any listed ICD-10 codes E10-E14 with X.1 or X.0. Race/ethnicity was reported on death certificates and categorized as Hispanic, non-Hispanic (NH) Asian/Pacific Islander (API), NH black (B), or NH white (W). Results were age standardized to the 2000 U.S. population by 10 year age groups. In 2013-2017, DM-related deaths were lowest among NH APIs (1.4, 95% CI 1.3, 1.5) followed by Hispanics (2.8, 95% CI 2.5, 2.7) and NHWs (3.2, 95% CI 3.0, 3.2), and highest among NHBs (7.7, 95% CI 7.5, 7.8) (Figure). Diabetes-related death rates increased for all groups from 1999-2002 to 2013-2017 (p &amp;lt; 0.05); DKA or diabetic coma rates increased among NHWs and NHBs (p &amp;lt; 0.05). Exploring reasons for increased diabetes-related mortality among youth and young adults may help reduce disparities and prevent deaths. Disclosure S. Shaydah: None. G. Imperatore: None. C. Mercado: None. K.M. Bullard: None. S.R. Benoit: None.

Hispanic and Black Patients with Adult B-Cell Acute Lymphoblastic Leukemia Have a Significantly Worse Survival in the Modern Era - a SEER 2010-2016 Analysis

Prior studies have evaluated incidence and survival trends for B-Acute Lymphoblastic Leukemia (B-ALL) in children and adults. However, there have been no recent studies evaluating the difference in survival between different race and ethnicities in the era of tyrosine kinase inhibitors and novel combination therapy. We wanted to determine 5-year observed survival for adult patients with B-ALL diagnosed in recent years and assess for any difference in survival by race-ethnicity. Methods: We used Surveillance Epidemiology End Results (SEER) 18 registry to identify B-ALL patients using ICD-O-3 codes 9811-9818 and 9836. SEER 18 covers ~28% of US population. The year of diagnosis was limited to 2010-2016 in order to capture a patient population most likely treated with modern therapies. We limited our study to adults aged 20 years (yrs) or more, which were then divided into the following age groups: 20-29, 30-39, 40-49, 50-59, 60-69,70-79,80+ yrs of age. Gender, race-ethnicity, median family income and observed overall survival (OS) were obtained from SEER. For multivariate survival analysis, Cox proportional hazard model was used to adjust for clinically important and other relevant variables (age, gender, race-ethnicity, median income). We included median family income, a county level characteristic in our analysis as a surrogate for access to care. We divided these counties into quintiles based on median family income and included that variable in the multivariate model. We did not adjust for genetic risk or patient insurance status, as the information provided in SEER was inadequate and would likely lead to misclassification bias. SEER Stat 8.3.5 and SAS student edition were used for analysis. Results: 4244 cases of B-ALL were identified with an age adjusted incidence rate of 0.92 per 100,000. B-ALL occurred at all ages, but incidence was higher in young adults (&amp;lt;30 yrs) and adults older than 50 yrs of age, with peak incidence noted in the oldest age group (80+yrs). Of note, our cohort included adults older than or equal to 20 yrs of age, hence did not capture the early peak of childhood B-ALL. Females had a statistically significant lower incidence of B-ALL as compared to males (Incidence rate ratio (IRR) 0.77, p-value&amp;lt;0.05). Table 1 lists counts and IRR by different patient characteristics. Age adjusted incidence was the highest among Hispanics (1.61{1.53-1.71}), followed by Non-Hispanic Whites (NHW)(0.77{0.73-0.8}, Non-Hispanic Asian Pacific Islander (NHAPI)(0.7{0.63-0.78}) and Non-Hispanic Blacks (NHB)(0.54{0.47-0.61}); this difference was statistically significant (p-value &amp;lt;0.05). When we evaluated the age adjusted incidence rate in each age group by different race-ethnicities, Hispanics had a statistically significant higher incidence in each age group except in 80+ yrs age group. About 52% of population died during the study period from any cause. We limited our survival analysis to patients without second malignancy to avoid the confounding effect of another cancer associated mortality. We evaluated OS differences between race-ethnicity in a multivariate model that adjusted for age, sex and income. We found that when compared to NHW, Hispanics (Hazard Ratio (HR) 1.3{1.16-1.46}; p&amp;lt;0.01) and NHB (HR 1.24{1.03-1.5};p 0.02) had worse overall survival. We also showed increased mortality in older than younger adults with B-ALL (Table 2), in line with prior knowledge. There was slightly decreased OS seen in males compared to females, and the difference barely reached statistical significance (HR 0.91{0.83-1.0}; p 0.05). Patients from the poorest counties had worse survival than those in counties with higher median income (Table 2). Conclusion: Our study showed a significant survival disparity in adult B-ALL by race and ethnicity in the modern era. This can partly be attributed to differences in access to care as shown in our study. Interestingly, Hispanic and NHB have a significantly worse overall survival compared to NHW and NHAPI even after accounting for income differences, as a surrogate for access to care. This could be due to other unaccounted measure of health disparity, availability of allogeneic transplantation and/or difference in disease biology. Further studies are needed to evaluate such differences, identify barriers to care in minority populations and characterize potential differences in the genetic make-up of B-ALL in the various ethnic/racial groups. Disclosures Sica: Physician's Education Resources (PER): Honoraria. Verma:Stelexis: Equity Ownership, Honoraria; Acceleron: Honoraria; Celgene: Honoraria; BMS: Research Funding; Janssen: Research Funding.

Racial and Ethnic Disparities in Lung Adenocarcinoma Survival: A Competing-Risk Model

BackgroundRace/ethnicity-specific disparities in lung cancer survival have been investigated extensively. However, more studies concentrating on lung adenocarcinoma (ADC), especially those using a competing-risk model, are needed. We examined race/ethnicity-specific differences in lung ADC survival. Patients and MethodsPatients with ADC diagnosed from 2004 to 2015 were identified from the Surveillance, Epidemiology, and End Results program. Race/ethnicity was categorized into 4 groups: non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian/Pacific Islander (NHAPI), and Hispanic. Lung cancer-specific mortality (LCSM) and other cause-specific mortality (OCSM) were evaluated using a competing-risk model. ResultsOn multivariate analysis, NHB patients experienced slightly lower LCSM (subdistribution hazard ratio, 0.96; 95% confidence interval, 0.94-0.98) and higher OCSM (subdistribution hazard ratio, 1.16; 95% confidence interval, 1.11-1.22) compared with NHW patients in the stage IV group. No significant differences were found in LCSM and OCSM between the NHB and NHW patients with early-stage ADC (stage I or II). Both NHAPI and Hispanic patients experienced lower OCSM and LCSM compared with the NHW patients. Additionally, NHB patients with stage IV tumors had a greater mortality risk of cardiovascular disease and a lower risk of chronic obstructive pulmonary disease than NHW patients. ConclusionsThe source of racial/ethnic survival disparities that exist between NHB and NHW patients was mainly found in patients with stage IV ADC. Reducing the greater mortality rate of cardiovascular disease among NHB patients and chronic obstructive pulmonary disease among NHW patients would be conducive to narrowing the racial/ethnic gaps. Further research is warranted to determine additional influencing factors, especially among patients with stage IV ADC.

Differences in Pancreatic Cancer Incidence Rates and Temporal Trends Across Asian Subpopulations in California (1988-2015).

Ethnic disparities in pancreatic cancer (PanCan) incidence exist, but little is known about incidence trends in heterogeneous Asian Americans. We examined PanCan incidence and temporal patterns among detailed ethnic populations, including Asian American subgroups. A total of 71,099 invasive exocrine PanCan cases were identified using the California Cancer Registry between 1988 and 2015. Cases were grouped into mutually exclusive groups of non-Hispanic (NH) white, NH black, Hispanic, NH Asian/Pacific Islander (API), and NH American Indian/Alaska Native (AIAN). Asians were further identified by specific ethnicity. The age-adjusted incidence rates (AAIRs, per 100,000) of PanCan varied significantly across racial/ethnic groups, ranging from the highest of 10.4 in NH blacks to 7.6 in NH whites, 7.1 in Hispanics, 6.2 in NH APIs, and to the lowest of 5.2 in NH AIAN. Despite the relatively low rate in the NH APIs, the rates across Asian subgroups varied significantly, with rates similar to NH whites in Japanese (8.1) and Koreans (7.5) to the low rate in South Asians (4.4). Significant heterogeneity of PanCan incidence in disaggregated Asian Americans is a novel finding. These results fill a gap regarding PanCan burden in Asian Americans and underscore the importance of disaggregating ethnic populations in cancer research.

Trends in stage at diagnosis for young breast cancer patients in the United States.

Previous studies reported increasing rates of metastatic breast cancer among young US women. However, these studies were based on limited geographic areas and did not account for the sharp decline in unknown-stage disease. In this study, we examined trends in early-onset breast cancer incidence rates by stage at diagnosis in a national dataset, after correcting for temporal changes in unstaged disease. Using data from 42 states, covering 82% of the US population, we examined trends in incidence rates by stage at diagnosis and race/ethnicity in women ages 20-39years. Stage was imputed for non-Hispanic (NH) white and NH black cases with missing information by distributing cases proportionally according to survival statistics. During 2001-2015, incidence rates of early-onset metastatic breast cancer increased sharply among NH white, NH black, Hispanic, and Asian/Pacific Islander (API) women. Increasing trends were also observed for local-stage disease (all racial/ethnic groups) and regional-stage disease (NH white and API). In contrast, rates decreased sharply for unstaged disease among all groups. After imputing stage for cases with missing information, the increasing trends for regional- and distant-stage disease in NH whites and local-stage disease in NH blacks were no longer statistically significant, but the increase in distant-stage disease in NH blacks was unchanged. After accounting for the sharp decline in unstaged cases, the increase in incidence rates for distant-stage disease became non-significant in NH whites but not in NH blacks. Future studies should consider accounting for temporal changes in unstaged disease when examining stage-specific incidence trends.