Comprehensive analysis of Native Hawaiians and other Pacific Islanders with early-onset colorectal cancer.

Abstract

31 Background: Rates of early-onset colorectal cancers (EOCRC) are increasing in Hawaii across all racial groups. Although previous studies have shown that Native Hawaiians have a higher mortality rate compared to other racial groups, the adjustment for sociodemographic factors have been limited. Our objective is to perform a comprehensive analysis of outcomes among patients with EOCRC in a racially diverse population accounting for tumor factors and patient sociodemographics. Methods: Patients diagnosed with EOCRC between 2000 and 2022 in Hawaii. Overall survival of Asians, Whites, and Native Hawaiian or Other Pacific Islanders (NHOPI) were calculated using the Kaplan-Meier method. Cox proportional hazard regression models assessed survival predictors adjusting for clinical and sociodemographic factors. Results: We included 379 patients in the final analysis. NHOPI had higher prevalence of underinsured status and higher histopathology grade compared to Whites and Asians. In unadjusted Cox regression, NHOPI race, underinsured status, grade, and stage were prognostic for survival. After adjusting for confounders, underinsured status, grade, and stage remained prognostic, but race was not significantly associated with survival. Conclusions: This study concludes that while NHOPI patients with EOCRC demonstrated poorer survival outcomes compared to other racial groups, this disparity was largely explained by the large percentage of underinsured NHOPI patients. Addressing treatment disparities in underinsured or uninsured is essential to improve survival outcomes. Univariate and multivariate analysis of survival. Univariate Multivariate HR (95% CI) p-value HR (95% CI) p-value Insurance Private Insurance - - - - Underinsured & Uninsured 1.865 (1.331-2.612) <0.001 1.843 (1.285-2.643) <0.001 Race White - - - - Asian 1.179 (0.746-1.865) 0.48 0.936 (0.585-1.496) 0.781 NHOPI 2.005 (1.231-3.265) 0.005 1.051 (0.714-1.547) 0.8 Age at diagnosis 0.996 (0.967-1.025) 0.771 1.002 (0.971-1.034) 0.901 Histopathology grade Grade 1&2 - - - - Grade 3&4 2.785 (1.958-3.963) <0.001 2.278 (1.571-3.303) <0.001 Stage Stage 1 - - - - Stage 2 1.104 (0.49-2.487) 0.81 1.028 (0.451-2.342) 0.948 Stage 3 3.255 (1.666-6.359) <0.001 2.873 (1.447-5.706) 0.003 Stage 4 14.851 (7.499-29.41) <0.001 12.778 (6.283-25.987) <0.001 Unknown 3.738 (1.506-9.275) 0.004 3.008 (1.189-7.608) 0.02 Sex Male - - - - Female 0.812 (0.587-1.123) 0.22 0.852 (0.609-1.194) 0.352 Microsatellite status Stable - - Unstable 0.481 (0.148-1.562) 0.204 Not done/Unknown 1.08 (0.737-1.582) 0.739 Time to Treatment Less than 1 month - - - - More than 1 month 1.221 (0.863-1.727) 0.26 1.123 (0.784-1.609) 0.527 Location of Tumors Right - - - - Left 1.239 (0.76-2.02) 0.391 1.466 (0.886-2.425) 0.137 Rectal 1.391 (0.86-2.249) 0.178 1.211 (0.738-1.986) 0.449 NHOPI: Native Hawaiians and Other Pacific Islanders; HR: Hazard Ratio; CI: Confidence Interval.