Widening Colon Cancer Disparities Post-Pandemic in Disaggregated Asian American and Pacific Islander Populations (2004–2021)

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Abstract
Colon cancer stage at diagnosis strongly predicts survival, yet racial disparities remain underexplored for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) subpopulations. In light of COVID-19 and rising anti-Asian hate, we examined temporal changes in colon cancer stage at diagnosis among disaggregated AANHPI populations before and during the pandemic. Using the National Cancer Database, we examined colon cancer stage at presentation (0-IV) among AANHPI subgroups in pre-pandemic (2004–2019) and pandemic (2020–2021) periods. Ordinal logistic regressions with race-year interaction terms evaluated odds of higher-stage diagnosis, adjusting for demographic, socioeconomic, and clinical factors. Among 913,119 patients, 28,845 (3.2%) were AANHPI. The yearly increase in odds of advanced-stage diagnosis was greater for Black than White patients (AOR, 1.008; 95% CI, 1.005–1.010; P < .001). Within-AANHPI subgroups, Thai patients had lower yearly odds of than the Chinese reference (AOR, 0.943, 95% CI, 0.903–0.986; P = .01). During the pandemic, disparities persisted or widened: Chinese (AOR 1.21, 95% CI, 1.05–1.38), Korean (AOR 1.35, 95% CI, 1.11–1.65), Vietnamese (AOR 1.26, 95% CI, 1.04–1.54), and Hmong (AOR 2.15, 95% CI, 1.19–2.36) patients exhibited higher odds of advanced-stage presentation than White patients. Significant heterogeneity exists in colon cancer stage at presentation among AANHPI subgroups. Disparities worsened during the pandemic, showing the importance of addressing subgroup-specific inequities in post-pandemic cancer care.
Funding Information
  • Richard K. Gershon Endowed Medical Student Research Fellowship
  • National Heart, Lung and Blood Institute of the National Institutes of Health

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