Identifying Asian American Lung Cancer Disparities: A Novel Analytic Approach

ObjectiveAsian Americans (AsAm) include heterogeneous subpopulations with unique burden as the only racial group with cancer as the leading cause of death. The purpose of the study was to identify differences in clinical stage (CS) and survival of patients with lung cancer between AsAm and its subgroups relative to other racial groups.MethodsPatients with lung cancer from 2016 National Cancer Database were divided into East Asian (EA), Southeast Asian (SEA), South Asian (SA) subgroups based on geographic origins, and a composite AsAm group with White Non-Hispanic (WNH), Black, and Hispanic comparison groups. Columnar z-score analysis with adjusted residuals was employed and the terms underrepresented and overrepresented were utilized to describe significant statistical findings.Results825,448 patients were analyzed. AsAm were underrepresented relative to WNH in all CS except IIIB and IV. In CS IV, AsAm (51.0%), EA (47.2%), SEA (57.4%), and SA (52.2%) were overrepresented relative to WNH (42.2%) and SEA were overrepresented relative to EA and SA. For survival across all stages, AsAm were overrepresented relative to WNH and Black, but in CS IV, SEA (17.9%) were underrepresented relative to EA (26.0%) and SA (26.6%).ConclusionThis is the first study to address lung cancer disparity in AsAm subgroups employing a novel analytical approach. AsAm subgroups demonstrated more advanced lung cancer diagnosis yet higher survival compared to WNH, Black and/or Hispanic with differences between subgroups. Interplay of complex factors may contribute to AsAm health disparities.