Burdens of Gastroenteropancreatic Neuroendocrine Neoplasm by Diverse Race and Ethnicities- A Rigorous Structural Equation Modeling.

Abstract

Background: It is unclear whether patients of all races and ethnicities with gastroenteropancreatic (GEP) neuroendocrine neoplasm (NEN) have equivalent incidence and cancer-specific survival.

Patients and methods: Using the California Cancer Registry, all patients with GEP-NEN in California's large and diverse population from 1992 to 2019 were identified. Age-adjusted incidence rates (AIRs) and cancer-specific mortality (CSM) risks were compared across racial and ethnic subgroups using structural equation modeling.

Results: The non-Hispanic (NH) Black population had the highest rate of diagnosis every year (AIR2019, 7.4 per 100,000; 95% CI, 6.4-8.5). The AIRs across races and ethnicities and primary sites vary, and in 2019 statistically significantly increased for stomach, small intestine, pancreatic, and rectal NEN and for only the NH White population. Risk of mortality was neutral across many races and ethnicities for many primary sites. The only statistically significant disparity was a higher CSM rate for Hispanic patients compared with NH Black patients with small intestine NEN (subdistribution hazard ratio, 1.45; 95% CI, 1.10-1.91; P=.008). Findings suggest a higher CSM among NH Black and NH White patients with rectal NEN. Disparities in who presents with GEP-NEN were revealed across racial and ethnic populations and primary sites. The NH Black population incurred the highest rate overall consistently every year. This is the first study to evaluate cancer-specific survival disparities in all GEP-NEN primary sites across the Asian American/Native Hawaiian/Pacific Islander, Hispanic, NH Black, and NH White racial and ethnic populations. Many clinical and sociodemographic measures associated with risk of mortality differed across race and ethnicities. After careful control of those imbalances, there were few racial and ethnic disparities in risk of CSM.

Conclusions: There is room to improve equity in the health care system and close the gap in diagnoses for the NH Black population with all GEP-NEN and in mortality for the Hispanic population with small intestine NEN.