Frances Dominique V Ho, Advait Thaploo, Katarina Wang, Aditya Narayan, Isabelle Rose I Alberto, Erika P Ong, Khushi Kohli, Mahi Kohli, Bhav Jain, Edward Christopher Dee, Scarlett Lin Gomez, James Janopaul-Naylor, Fumiko Chino
{"title":"按亚裔美国人、夏威夷原住民和太平洋岛民分类的宫颈癌发病阶段差异。","authors":"Frances Dominique V Ho, Advait Thaploo, Katarina Wang, Aditya Narayan, Isabelle Rose I Alberto, Erika P Ong, Khushi Kohli, Mahi Kohli, Bhav Jain, Edward Christopher Dee, Scarlett Lin Gomez, James Janopaul-Naylor, Fumiko Chino","doi":"10.1016/j.ajog.2024.08.027","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the AANHPI community, prior studies in cervical cancer have considered this group in aggregate.</p><p><strong>Objective(s): </strong>We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated AANHPI groups.</p><p><strong>Study design: </strong>Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer was retrospectively analyzed. AANHPI patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus non-metastatic disease at diagnosis.</p><p><strong>Results: </strong>Out of 122,926 patients with cervical cancer, 5,142 (4.2%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients presented at lower stages of cancer (NHW: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Filipino Americans (n=1051, 20.4% of AANHPI), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. AANHPI disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (aOR 1.58, 95% CI 1.21-2.06, p = 0.001) relative to non-Hispanic White patients. Conversely, Chinese American (aOR 0.47, 95% CI 0.37-0.59, p < 0.001), Vietnamese American (aOR 0.54, 95% CI 0.41-0.70, p < 0.001), Hmong American (aOR 0.46, 95% CI 0.22-0.97, p = 0.040), and Indian/Pakistani American (aOR 0.76, 95% CI 0.61-0.94, p = 0.013) patients were less likely to present with metastatic disease. Compared to the largest AANHPI group (Chinese American), nine other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (aOR 3.44, 95% CI 2.41-4.91, p < 0.001), Thai American (aOR 2.79, 95% CI 1.41-5.53, p = 0.003), Kampuchean American (aOR 2.39, 95% CI 1.29-4.42, p = 0.006), Native Hawaiian American (aOR 2.23, 95% CI 1.37-3.63, p = 0.001), and Laotian American (aOR 2.02, 95% CI 1.13-3.61, p = 0.017). In contrast, Vietnamese American (aOR 1.20, 95% CI 0.85-1.71, p = 0.303) and Hmong American (aOR 1.09, 95% CI 0.50-2.37, p = 0.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.</p><p><strong>Conclusion(s): </strong>Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population - including Pacific Islander American and Thai American patients - may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.\",\"authors\":\"Frances Dominique V Ho, Advait Thaploo, Katarina Wang, Aditya Narayan, Isabelle Rose I Alberto, Erika P Ong, Khushi Kohli, Mahi Kohli, Bhav Jain, Edward Christopher Dee, Scarlett Lin Gomez, James Janopaul-Naylor, Fumiko Chino\",\"doi\":\"10.1016/j.ajog.2024.08.027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the AANHPI community, prior studies in cervical cancer have considered this group in aggregate.</p><p><strong>Objective(s): </strong>We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated AANHPI groups.</p><p><strong>Study design: </strong>Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer was retrospectively analyzed. AANHPI patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus non-metastatic disease at diagnosis.</p><p><strong>Results: </strong>Out of 122,926 patients with cervical cancer, 5,142 (4.2%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients presented at lower stages of cancer (NHW: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Filipino Americans (n=1051, 20.4% of AANHPI), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. AANHPI disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (aOR 1.58, 95% CI 1.21-2.06, p = 0.001) relative to non-Hispanic White patients. Conversely, Chinese American (aOR 0.47, 95% CI 0.37-0.59, p < 0.001), Vietnamese American (aOR 0.54, 95% CI 0.41-0.70, p < 0.001), Hmong American (aOR 0.46, 95% CI 0.22-0.97, p = 0.040), and Indian/Pakistani American (aOR 0.76, 95% CI 0.61-0.94, p = 0.013) patients were less likely to present with metastatic disease. Compared to the largest AANHPI group (Chinese American), nine other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (aOR 3.44, 95% CI 2.41-4.91, p < 0.001), Thai American (aOR 2.79, 95% CI 1.41-5.53, p = 0.003), Kampuchean American (aOR 2.39, 95% CI 1.29-4.42, p = 0.006), Native Hawaiian American (aOR 2.23, 95% CI 1.37-3.63, p = 0.001), and Laotian American (aOR 2.02, 95% CI 1.13-3.61, p = 0.017). In contrast, Vietnamese American (aOR 1.20, 95% CI 0.85-1.71, p = 0.303) and Hmong American (aOR 1.09, 95% CI 0.50-2.37, p = 0.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.</p><p><strong>Conclusion(s): </strong>Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population - including Pacific Islander American and Thai American patients - may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.</p>\",\"PeriodicalId\":7574,\"journal\":{\"name\":\"American journal of obstetrics and gynecology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":8.7000,\"publicationDate\":\"2024-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of obstetrics and gynecology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajog.2024.08.027\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of obstetrics and gynecology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajog.2024.08.027","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Cervical cancer disparities in stage at presentation for disaggregated Asian Americans, Native Hawaiians, and Pacific Islanders.
Background: Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander (AANHPI) in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the AANHPI community, prior studies in cervical cancer have considered this group in aggregate.
Objective(s): We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated AANHPI groups.
Study design: Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer was retrospectively analyzed. AANHPI patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus non-metastatic disease at diagnosis.
Results: Out of 122,926 patients with cervical cancer, 5,142 (4.2%) identified as AANHPI. Compared to non-Hispanic White (NHW) patients, pooled AANHPI patients presented at lower stages of cancer (NHW: 58.7% diagnosed local/regional, AANHPI: 85.6% at local/regional, χ2 P<0.001). The largest AANHPI subgroups included Filipino Americans (n=1051, 20.4% of AANHPI), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. AANHPI disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (aOR 1.58, 95% CI 1.21-2.06, p = 0.001) relative to non-Hispanic White patients. Conversely, Chinese American (aOR 0.47, 95% CI 0.37-0.59, p < 0.001), Vietnamese American (aOR 0.54, 95% CI 0.41-0.70, p < 0.001), Hmong American (aOR 0.46, 95% CI 0.22-0.97, p = 0.040), and Indian/Pakistani American (aOR 0.76, 95% CI 0.61-0.94, p = 0.013) patients were less likely to present with metastatic disease. Compared to the largest AANHPI group (Chinese American), nine other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (aOR 3.44, 95% CI 2.41-4.91, p < 0.001), Thai American (aOR 2.79, 95% CI 1.41-5.53, p = 0.003), Kampuchean American (aOR 2.39, 95% CI 1.29-4.42, p = 0.006), Native Hawaiian American (aOR 2.23, 95% CI 1.37-3.63, p = 0.001), and Laotian American (aOR 2.02, 95% CI 1.13-3.61, p = 0.017). In contrast, Vietnamese American (aOR 1.20, 95% CI 0.85-1.71, p = 0.303) and Hmong American (aOR 1.09, 95% CI 0.50-2.37, p = 0.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.
Conclusion(s): Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger AANHPI population - including Pacific Islander American and Thai American patients - may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community based disaggregated research and tailored interventions is necessary to close these gaps.
期刊介绍:
The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare.
Focus Areas:
Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders.
Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases.
Content Types:
Original Research: Clinical and translational research articles.
Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology.
Opinions: Perspectives and opinions on important topics in the field.
Multimedia Content: Video clips, podcasts, and interviews.
Peer Review Process:
All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.