Aggregating Data Hides Cancer Disparities Affecting Asian and NHPI Patients in the US

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In medical research, Asian-American patients have often been treated as a monolith, grouped together with Native Hawaiian and other Pacific Islander (NHPI) patients.1

However, studies have shown that this type of aggregation may mask large disparities in cancer incidence and outcomes among these patient groups.

For example, researchers found that patients with Southeast Asian ancestry had the highest risk of developing hepatocellular carcinoma2 And the worst survival rate after breast cancer.3 Laotian Americans at highest risk of nasopharyngeal cancerFour High risk of death after liver cancer.Five

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A study of nine common cancers in the United States showed superior survival outcomes for patients of East, South, and Southeast Asian ancestry, and inferior outcomes for patients with NHPI.6

“Aggregating data will inevitably group people in a variety of ways, such as country of origin, genetic ancestry, disease frequency, socioeconomic status, immigration patterns, diet and cultural practices, to name a few. You run the risk of blurring the lines between them,” said Alice Yunji Yu, M.D., of Lurie Children’s Hospital in Chicago.

According to Kekoa Taparra MD, PhD, Stanford University School of Medicine in California, at a broader level, aggregating data from different groups may help address the health disparities that affect these people. It leads to a lack of awareness and funding.

Asian and NHPI patients have different outcomes

Dr. Taparra noted that NHPI patients are often grouped together with Asian patients, even though they represent two different ethnic groups.1

“Despite this common practice in the medical literature, NHPI individuals are not the same as Asian individuals and should never be counted together. It hides a lot of differences,” explained Dr. Tapala.

so Research published last yearDr. Tapala and colleagues examined data from nine common cancer patients in the United States.6 Researchers found that patients of East Asian, South Asian, and Southeast Asian ancestry generally had better overall survival (OS) than non-Hispanic white (NHW) patients. Southeast Asian lymphoma patients were the only Asian group with inferior OS compared with NHW patients.

On the other hand, NHPI patients did not have superior OS for any of the nine cancers compared with NHW patients. Indeed, NHPI patients had inferior OS for oral cancer, lymphoma, endometrial cancer, prostate cancer, and breast cancer.

Dr. Taparra and colleagues also examined data from a study showing a 91% 10-year OS rate for Asian Americans with early-stage breast cancer and NHPI patients.7 However, disaggregated data showed differences in 10-year OS between subgroups of patients.

Compared with NHW patients, NHPI patients had a higher risk of death (adjusted hazard ratio [aHR]1.38), East Asian (aHR, 0.57), South Asian (aHR, 0.66), and Southeast Asian (aHR, 0.78) patients had a lower risk of death.

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