Disaggregating AANHPI Patients With NSCLC Reveals Survival Disparities in Stage, Treatment Delays, and Mortality

BackgroundAsian American Native Hawaiian Pacific Islander (AANHPI) patients are generally studied together despite diverse social, cultural, and economic backgrounds. We investigated survival disparities in disaggregated AANHPI lung cancer patients.MethodsThis retrospective cohort study identified 1,093,916 White, African American, and AANHPI non-small cell lung cancer (NSCLC) patients from the National Cancer Database (2010-2019). AANHPI subgroups included Chinese, Japanese, Filipino, Korean, Vietnamese, Indian, and "other." Multivariate analyses assessed disparities in stage at presentation, time to surgery, and survival.ResultsAggregate data demonstrated AANHPI patients have superior survival than Whites and African Americans (median survival 31.8 vs 19.2 vs 16.2 months, respectively). Disaggregation revealed disparities: Chinese patients have the best outcomes (46.2 months) while Japanese patients have the worst (17.7 months) with a 68% higher mortality risk than Whites (HR 1.68). Filipino patients demonstrated a 27% increased likelihood of stage IV presentation (HR 1.27), a 50% higher surgical delay risk (HR 1.50), and a 33% increased mortality risk (HR 1.33). Vietnamese patients have similar stage IV presentation and surgical delay risks, reducing survival. Of the AANHPI subgroups, Chinese patients had the best survival.DiscussionWhile AANHPI patients generally demonstrate better survival than Whites and African Americans, heterogeneity exists within AANHPI subgroups. Chinese patients experienced the best outcomes, while Japanese, Filipino, and Vietnamese patients faced poor survival due to increased risk of late diagnosis and surgical delay. This underscores the importance of disaggregating AANHPI populations in cancer outcomes research and the need for culturally tailored strategies to improve screening, timely treatment, and survival.