Disparities in stomach cancer stage among disaggregated asian populations

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.

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.

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.

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

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.

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.

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).

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.

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.