Nasopharyngeal cancer mortality in disaggregated Asian and non-Asian Americans.
Authors: Hung George A. , Vohra Sanah , Kim Gina , Jamal Armaan , Srinivasan Malathi , Huang Robert J. , Kim Gloria , Palaniappan Latha , Colevas Alexander Dimitrios 
Published: June 2024

e18074 Background: Nasopharyngeal carcinoma (NPC) is one of the most common forms of head and neck cancer with an overall five-year survival rate of 63%. In Asian populations, NPC prevalence is 50 times the global rate and early detection has been shown to reduce mortality. NPC survival and mortality rates are influenced by risk factors including Epstein-Barr virus exposure, human papillomavirus infection, human leukocyte antigen genotype, alcohol consumption, tobacco use, diet, age, sex, nativity, and race/ethnicity. Male NPC mortality is more than double females, and mortality is highest in individuals over 80 years old (y/o). Geographic differences abound. In Asia, Vietnam has one of the highest NPC mortality rates, nearly 5 times the global rate. While China and the Philippines report NPC mortality rates 2 times higher than the global rate, South Korea, India, and Japan all report rates significantly lower. In the United States (US), most studies on NPC mortality have not disaggregated Asian subgroups to examine within group variation. A 25-year study of NPC in Asians ending in 2009 found Asian Americans to have a 5.6 times higher age-adjusted mortality rate (AAMR per 100,000 person-years) than Non-Hispanic Whites (NHW), 6.7 times higher than Hispanic Whites (HW), and 3.3 times higher than Blacks. US death certificate standardization started in 2005, making disaggregated Asian mortality information available. One study reported NPC mortality rates for Chinese, Korean, Filipinos, and Asian Indians living in New York City disaggregated by sex but did not account for nativity or age. Another group generated hazard ratios for NPC mortality, disaggregated by Asian race, age, and sex but similarly did not account for nativity. With the Asian population becoming the fastest growing racial group in the US, there is a corresponding need for disaggregated mortality data, essential for analyzing specific diseases that affect particular Asian races and subpopulations at higher rates. Methods: Using the 2005-2020 National Vital Statistics System and American Community Survey, we examined NPC mortality by age, race (Black, HW, NHW, Chinese, Filipino, Asian Indian, Japanese, Korean, Vietnamese), sex, and nativity (US or foreign-born). Results: Upon disaggregation, Chinese (1.96 [CI: 1.78-2.16]), Filipino (0.68 [0.68-1.11]), and Vietnamese Americans (0.68 [0.52-1.10]) had the top three AAMR. Foreign-born Chinese, Vietnamese, Filipinos, Asian Indians, and NHW had higher AAMRs compared to US-born persons. Males had higher AAMR compared to females for all groups. All races except for Blacks had the highest NPC mortality rate among 80+ y/o. Stratifying for race, nativity, and sex, foreign-born Chinese males (4.09 [3.79-4.40]) had the highest AAMR. Conclusions: These findings demonstrate the importance of disaggregating NPC mortality data by Asian subgroups, providing valuable insights for targeted public health interventions in the US.