Abstract 1179: Renal cell carcinoma health disparities in American Indians Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry data
Authors: Batai Ken , Asmar Samer , Gachupine Francine C. , Chipollini Juan , Lee Benjamin R. 
Published: September 2020

Abstract
Background: American Indians/Alaska Natives (AIs/ANs) and United States (U.S.)-born Hispanic Americans (HAs) have higher kidney cancer mortality rates compared to non-Hispanic Whites (NHWs), but kidney cancer burden among these racial/ethnic minority groups are not well understood. The aim of our study was to evaluate the burden of renal cell carcinoma (RCC) among these groups at a State (Arizona) and national level with a focus on advanced stage (stage III/IV) diagnosis, indicative of delayed diagnosis, and overall poorer survival.
Methods: A retrospective analysis of National Cancer Database (NCDB) and Arizona Cancer Registry (ACR) was conducted. RCC patients diagnosed between 2004 and 2015 in NCDB and between 2007 and 2016 in ACR with known race/ethnicity information were included. Multivariable logistic regression and Cox regression analysis were performed to ascertain the effect of race/ethnicity stage and overall survival.
Results: There were a total of 405,073 cases in NCDB and 9,743 cases in ACR. In NCDB data, advanced stage was more common in AIs/ANs (31.5%) and HAs (28.6%) compared to NHWs (27.7%), but associations were not statistically significant. Among HAs, Mexican Americans were more likely to have advanced stage (34.1%) and had higher odds of advanced stage diagnosis compared to NHWs (OR 1.22, 95% CI: 1.11-1.35). In ACR, advanced stage diagnosis was common in Mexican Americans (47.2%), particularly U.S.-born Mexican Americans (49.1%). Advanced stage diagnosis was also more common in AIs/ANs compared to NHWs (31.5% vs. 26.4%). AIs/ANs and Mexican Americans had increased odds of advanced stage diagnosis compared to NHWs (OR 1.39, 95% CI: 1.08-1.79 and OR 2.08, 95% CI: 1.65-2.62 respectively). Risk of mortality was assessed adjusting for stage, surgical treatment, and socio-demographic factors. In NCDB, HAs had reduced mortality risk (HR 0.88, 95% CI: 0.85-0.91). Among HAs, HAs of South or Central American origin had the greatest reduced risk of mortality (HR 0.74, 95% CI: 0.59-0.92). In Arizona, AIs/ANs and HAs had significantly higher risk of mortality compared to NHWs (HR 1.55, 95% CI: 1.18-2.04 and HR 1.36, 95% CI: 1.14-1.64). The greatest risk of mortality was observed in U.S.-born Mexican Americans (HR 3.76, 95% CI: 2.97-4.76).
Conclusion: Greater health disparities were observed in Arizona, at the State level than the national level. A Hispanic paradox was observed at the national level but not at the State level, Arizona.
Impact: It is necessary to further investigate RCC health disparities at a State level, including regional variations in healthcare systems, rurality or distance to tertiary referral centers, and patient-related factors, such as access to care and co-morbidity, that contribute to racial health disparities.
Citation Format: Ken Batai, Samer Asmar, Francine C. Gachupine, Juan Chipollini, Benjamin R. Lee. Renal cell carcinoma health disparities in American Indians Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry data [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1179.