Comprehensive Analysis of Native Hawaiians and Other Pacific Islanders with Early Onset Colorectal Cancer

Rates of early-onset colorectal cancers (EOCRC) are increasing in Hawaii across all racial groups. Previous studies have shown that Native Hawaiians have a higher mortality rate compared to other racial groups; however, these studies only performed limited adjustments for sociodemographic factors. Our objective is to conduct a comprehensive analysis of outcomes among patients with EOCRC in a racially diverse population accounting for tumor factors and patient sociodemographics.

Data were abstracted for patients under the age of 50 years diagnosed with colorectal cancer between 2000 and 2022 in Hawaii. Overall survival of Asians, Whites, and Native Hawaiian or Other Pacific Islanders (NHOPI) was calculated using the Kaplan-Meier method. Two Cox proportional hazards regression models were created to assess predictors of survival: a minimally adjusted model (age, sex, stage, and race) and a fully adjusted model (also included insurance status, pathology grade, and tumor location).

A total of 379 patients were included in the final analysis (54.6% Asian, 19.8% White, 25.6% NHOPI). NHOPI patients more often had Medicaid or were uninsured (p < 0.001) and their cancers had a higher histopathology grade compared to White and Asian groups (p = 0.022). In the unadjusted Cox regression model, NHOPI race (Hazard ratio [HR] 2.005, 95% confidence interval [CI] = 1.231-3.265, p = 0.005), having Medicaid or being uninsured (HR 1.865, 95% CI = 1.331-2.612, p < 0.001), grade and stage were prognostic for survival. However, after adjusting for confounders, having Medicaid or being uninsured, grade, and stage remained prognostic factors, but race was not significantly associated with survival in both minimally and fully adjusted model (HR 1.534, 95% CI = 0.931-2.528, p = 0.093) (HR 1.138, 95% CI = 0.682-1.900, p = 0.757).

This study concludes that while NHOPI patients with EOCRC demonstrated poorer survival compared to other racial groups, this disparity was largely explained by the large percentage of Medicaid and uninsured NHOPI patients. Additionally, the significantly higher histopathology grade in NHOPI explained the worsening survival. This study emphasizes the importance of addressing disparities in treatment access and utilization to improve outcomes. Further study is also needed to understand the mechanism underlying the higher tumor grade among NHOPI.