Racial disparities in incidence and mortality among AYA patients with lung adenocarcinoma and squamous cell carcinoma in the US: A SEER database analysis.

Abstract

e13744 Background: Despite a steady increase in the incidence of adolescent and young adult (AYA) lung cancer in the US, racial disparities involving lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) in this population are still understudied. We performed the Surveillance, Epidemiology, and End Results (SEER) database analysis to determine the effect of race/ethnicity and the incidence, trend, and mortality in AYA patients with LUAD and LUSC. Methods: AYA cases (aged 15-39) with LUAD or LUSC diagnosed between 2000 and 2021 were retrieved through the SEER database. Age-adjusted incidence rate (AAIR), annual percent change (APC), and incidence rate ratio (IRR), along with 95% confidence interval (CI), were calculated using SEER*Stat v.8.4.4. Survival analysis was performed using R v.4.3.2. Results: In total, 4,813 and 776 cases of LUAD and LUSC were retrieved from the SEER database, with 2,983 (53.4%) being female. Non-Hispanic White (NHW), Non-Hispanic Black (NHB), Non-Hispanic Asian/Pacific Islander (NHAPI), Non-Hispanic American Indian/Alaska Native (NHAIAN), and Hispanic patients comprised 2940 (52.6%), 790 (14.1%), 816 (14.6%), 18 (0.3%), and 1,025 (18.4%) cases, respectively. NHB males and NHAPI of both sexes had increased IRR for LUAD compared to NHW. In contrast, Hispanics had a decreased risk compared to NHW. For LUSC, NHAPI females and Hispanics of both sexes had reduced IRR compared to NHW ( Table 1 ). Only NHWs had significant decreases in AAIR for LUAD (APC -1.75 (95%CI -3.04-(-0.44)) for males and -2.13 (95%CI -2.93-(-1.32)) for females) and LUSC (APC -3.56 (95%CI -5.61-(-1.47)) for males and -5.38 (95%CI -8.11-(-2.57)) for females). In terms of mortality from LUAD, NHB had increased mortality (hazard ratio (HR) 1.29, 95%CI 1.16-1.44, p < 0.001), while NHAPI had decreased mortality compared to NHW (HR 0.83, 95%CI 0.75-0.93, p = 0.001). For LUSC, only NHAIAN males had an increased mortality compared to NHW (HR 2.16, 95%CI 1.11-4.21, p = 0.02). Conclusions: Over the last 20 years AAIR for lung cancer declined in NHWs but remained unchanged in all minority groups. NHBs with LUAD and NHAIAN males with LUSC also had higher mortality risks compared to NHWs. Our findings illustrate the need for an equitable distribution of preventive interventions across all ethnic groups. IRR and 95% CI of LUAD and LUSC during 2000-2021 by race/ethnicity. LUAD LUSC Male Female Male Female NHW 1 (ref) 1 (ref) 1 (ref) 1 (ref) NHB 1.38 (1.22-1.57, p<0.001) 0.98 (0.87-1.10, p=0.76) 1.20 (0.91-1.56, p=0.19) 1.04 (0.74-1.42, p=0.86) NHAPI 1.74 (1.53-1.97 p<0.001) 1.49 (1.33-1.67 p<0.001) 0.90 (0.64-1.25, p=0.60) 0.56 (0.34-0.88, p=0.01) NHAIAN 0.54 (0.15-1.34, p=0.24) 0.50 (0.18-1.10, p=0.10) 2.79 (0.90-6.34, p=0.07) 1.99 (0.39-5.77, p=0.40) Hispanic 0.76 (0.68-0.85 p<0.001) 0.66 (0.59-0.73 p<0.001) 0.44 (0.33-0.58, p<0.001) 0.60 (0.44-0.81, p<0.001)