Disparities in Cancer Mortality Among Asian Americans and Pacific Islanders

Cancer remains the leading cause of death for Asian American individuals and the second leading cause for Native Hawaiian and Pacific Islander populations in the US. A recent study examined longitudinal trends in cancer mortality from 1999 to 2020 among these groups, highlighting critical disparities based on age, sex, cancer type, and geographic location.¹

Despite an overall decline in cancer-specific mortality, certain cancer types are being linked to rising death rates among Asian American and Pacific Islander populations. | Image credit: Yurii Kibalnik - stock.adobe.com

This cross-sectional study is published in JAMA Network Open.

“In this study, we evaluated cancer-specific mortality trends over 2 decades to comprehensively assess the burden of cancer among Asian American and Pacific Islander individuals,” wrote the researchers of the study. “We aimed to broadly describe these trends both overall and by sex, age, and geographic variations across a wide range of cancer types, thereby informing more targeted clinical and public health interventions to address disparities in cancer mortality.”

Despite the high burden of cancer mortality among this patient population, lack of trust and isolation has left members of the Asian American, Native Hawaiian, and Pacific Islander communities largely underrepresented in clinical trials.²

“Trust issues are a major challenge in Hawaii, and it's a historical aspect that we need to recognize that Hawaii belongs to Native Hawaiians,” explained Naoto T. Ueno, MD, PhD, FACP, director and interim program coleader, Cancer Biology Program, Translational and Clinical Research, University of Hawaiʻi Cancer Center, to The American Journal of Managed Care^® (AJMC^®). “Basically, the businesspeople came, and they threw away the Kingdom of Hawaii, and the statehood was somewhat controversial. There is a differing opinion about how we should be seeing our relationship to the USs. We recognize that we're part of the US, but at the same time, it’s a sensitive issue among the Native Hawaiians, due to cultural suppression—the language was suppressed at the public school until the late ’70s.”

In this study, cancer mortality data were sourced from the CDC WONDER Underlying Cause of Death database, covering January 1, 1999, to December 31, 2020.¹ The study utilized International Classification of Diseases, Tenth Revision (ICD-10) codes to identify 18 specific cancer types, including bladder, brain, breast, colorectal, liver, pancreatic, and others.

Additionally, age-adjusted cancer-specific mortality (CSM) rates were calculated per 100,000 population, adjusted to the 2000 US standard population. Rates were examined overall and by sex, cancer type, age group, and US Census region.

Between 1999 and 2020, 305,386 Asian American and Pacific Islander individuals died from cancer in the US. During this period, the overall CSM rate declined by 1.5% annually. Men saw a larger decrease in CSM rates (1.8%) compared with women (1.1%).

However, certain cancer types showed rising mortality trends among women, particularly uterine cancer (2.5%) and brain and central nervous system cancers (1.4%). Among men aged 45 to 54 years, colorectal cancer mortality increased (1.3%). Additionally, liver and intrahepatic bile duct cancer mortality rose for both sexes across all US census regions, while uterine cancer mortality increased for women and pancreatic cancer mortality increased for both men and women in the Midwest.

This study has several limitations. First, it relied on death certificates, which are prone to misclassification. Additionally, key clinical and social factors—such as cancer stage, treatment details, income, education, health literacy, and smoking status—were not included, limiting a comprehensive analysis of cancer mortality disparities. The aggregation of Asian American and Pacific Islander populations also obscured differences between specific ethnic subgroups, who may face unique cancer risks. Moreover, geographic trends were analyzed at the Census-region level, potentially masking important state and local variations.

Therefore, the researchers believe that future research should incorporate disaggregated data and additional social and demographic factors to better understand and address disparities in cancer outcomes.

“In this cross-sectional study, we found that overall CSM rates decreased among Asian American and Pacific Islander individuals from 1999 to 2020, but specific cancer types exhibited increased mortality rates, with further disparities by sex, age, and US region,” wrote the researchers. “Targeted, culturally adapted clinical and public health interventions are imperative to narrowing disparities in cancer mortality.”

References

1. Zhu DT, Pompa IR, Qi D, et al. US cancer mortality trends among Asian and Pacific Islander populations. JAMA Netw Open. 2024;7(11):e2442451. doi:10.1001/jamanetworkopen.2024.42451.

2. Gerlach A, Joszt L. Creating equitable cancer care for Americans of Asian and Pacific Islander heritage. AJMC. October 15, 2024. Accessed November 4, 2024. https://www.ajmc.com/view/creating-equitable-cancer-care-for-americans-of-asian-and-pacific-islander-heritage