Abstract C082: Survival and treatment disparities of Hmong patients diagnosed with gastrointestinal cancer
Authors: Avila Cinthya Maldonado , Schiefelbein Andrea , Walker Margaret , Lor Kajua , Hampton John , Vidri Roberto J. , LoConte Noelle K. , Skala Melissa , Zafar Nabeel 
Published: December 2023

Abstract
Purpose: This study seeks to investigate disparities in treatment and survival for Hmong patients with gastrointestinal cancers in Wisconsin. Background: The Hmong community is one of the largest resettled communities in the U.S composed of ethnic minority refugees from Southeast Asia that migrated during the Vietnam War and as political refugees. Wisconsin has the third largest Hmong population in the U.S. Compared to Non-Hispanic Whites (NHW), Hmong face greater cancer mortality rates; distinct disparities may be underappreciated, as Hmong outcomes are often grouped with Asian Americans. Thus, differences in treatment and survival between NHW and Hmong populations remain understudied. Methods: Adults with liver, pancreas, or colorectal cancer diagnosed from 2004-2018 in the Wisconsin Cancer Reporting System were included. Summary statistics comparing Hmong, NHW, and Non-Hmong Asian individuals were generated. Adjusted logistic regression models were used to test differences in treatments. Adjusted Cox proportional hazard regression models were constructed to test differences in cause-specific survival (CPS) for liver and CRC and all-cause survival for pancreas cancer. Model A (A) adjusted for sociodemographic variables only: age, sex, race/ethnicity, rurality, county, median household income and education status, insurance, and stage. Model B (B) added treatment variables chemotherapy, surgery, and radiation. Results: Of 56,163 patients, 5,822 had liver cancer with 22 (0.4%) identifying as Hmong, 8,490 had pancreatic cancer with 11 (0.001%) identifying as Hmong, and 37,851 had CRC with 50 (0.001%) identifying as Hmong. For all cancer types, Hmong patients were diagnosed at a younger age and trended toward decreased survival. The average age at diagnosis was significantly lower for Hmong patients with liver cancer compared to NHW patients (55.3 years VS 67.6 years, p&lt;0.001). Hmong patients with liver and pancreatic cancers had lower odds of receiving chemotherapy (OR=0.28, [0.09, 0.80], OR=0.03, [0.003, 0.24], and a trend towards lower odds of receiving chemotherapy (OR=0.60, [0.27, 1.20]) for CRC. All cancers trended toward lower odds of receiving surgery (OR=0.46, [0.12, 1.74], OR=0.61, [0.06, 5.42], OR=0.62, [0.26, 1.47], respectively. Compared to NHW patients, Hmong patients with liver cancer had an increased hazard of death (HR 2.67, [1.54, 4.63]) when considering sociodemographic variables (A). Adjustment for treatment variables reduced this disparity in (B) (HR 1.56, [0.90-2.72]). Conclusions: Hmong patients across all cancers were more likely to be diagnosed at a younger age and trended toward lower survival. Those with liver and pancreatic cancer also had lower odds of receiving chemotherapy. These findings highlight inequities in healthcare with the goal to drive greater access to and acceptance of treatment and community outreach. Future efforts will focus on disseminating this information and developing community-based approaches for health screening and prevention.
Citation Format: Cinthya Maldonado Avila, Andrea Schiefelbein, Margaret Walker, Kajua Lor, John Hampton, Roberto J. Vidri, Noelle K. LoConte, Melissa Skala, Nabeel Zafar. Survival and treatment disparities of Hmong patients diagnosed with gastrointestinal cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C082.