Disparities in stomach cancer stage among disaggregated asian populations.

IMPORTANCE

Stomach cancer is a leading cause of cancer-related death globally, and stage at diagnosis is a key predictor of survival. Most U.S. studies aggregate Asian American, Native Hawaiian, and Pacific Islander (AANHPI) individuals into a single group, masking meaningful disparities in cancer stage at diagnosis.

OBJECTIVE

To examine disparities in stomach cancer stage at diagnosis among disaggregated AANHPI subgroups compared with Non-Hispanic White patients and among AANHPI subgroups themselves, and to assess how these disparities evolved during the COVID-19 pandemic.

DESIGN

Retrospective cohort study using data from the National Cancer Database (NCDB), a hospital-based registry covering approximately 70% of U.S. cancer cases, from 2004 to 2021.

SETTING

Multicenter, hospital-based data from over 1500 Commission on Cancer-accredited facilities in the United States.

PARTICIPANTS

Adults aged ≥ 40 years diagnosed with primary stomach cancer. Of 293,381 initially identified, 187,400 were included after excluding patients with missing stage or covariates. Participants were categorized into disaggregated racial/ethnic subgroups including 13 AANHPI categories.

EXPOSURES: Self-reported race/ethnicity, disaggregated into detailed AANHPI subgroups. The primary exposure was race/ethnicity; covariates included insurance, income, education, comorbidity, facility type, and diagnosis year.

MAIN OUTCOMES AND MEASURES: Stage of stomach cancer at diagnosis (ordinal: Stage 0-IV). Multivariable ordinal logistic regression assessed adjusted odds of later-stage diagnosis. Analyses were stratified by time period (pre-pandemic vs pandemic) and by AANHPI subgroup (reference: Chinese).

RESULTS

Of 187,400 patients (mean [SD] age 67.5 [11.9] years; 63.4% male), 7.1% identified as AANHPI. Chinese, Korean, and Japanese patients had significantly lower odds of late-stage diagnosis than White patients. Filipino and Hmong patients had significantly higher odds. Compared to Chinese patients, most AANHPI subgroups (e.g., Filipino [AOR 1.53, 95% CI 1.33-1.76], Hmong [AOR 2.02, 95% CI 1.40-2.91]) had higher odds of late-stage diagnosis. During the pandemic period, Thai and Hawaiian patients had higher adjusted odds of later-stage diagnosis in stratified analyses, although subgroup-specific estimates must be interpreted with caution because of smaller sample sizes.

CONCLUSIONS AND RELEVANCE: Significant disparities in stomach cancer stage exist both between and within AANHPI subgroups. Disaggregated data are essential to uncover hidden inequities and inform targeted, culturally responsive interventions and screening strategies.