Ho Frances Dominique V, Thaploo Advait, Wang Katarina, Narayan Aditya, Alberto Isabelle Rose I, Ong Erika P, Kohli Khushi, Kohli Mahi, Jain Bhav, Dee Edward Christopher, Gomez Scarlett Lin, Janopaul-Naylor James, Chino Fumiko
College of Medicine, University of the Philippines - Manila, Manila, Philippines.
University of Pennsylvania, Philadelphia, PA.
Am J Obstet Gynecol. 2025 Mar;232(3):310.e1-310.e15. doi: 10.1016/j.ajog.2024.08.027. Epub 2024 Aug 22.
Over 20 million people in the United States identified as Asian American, Native Hawaiian, or Pacific Islander in 2022. Despite the diversity of immigration histories, lived experiences, and health needs within the Asian American, Native Hawaiian, or Pacific Islander community, prior studies in cervical cancer have considered this group in aggregate.
We sought to analyze disparities in cervical cancer stage at presentation in the United States, focusing on disaggregated Asian American, Native Hawaiian, or Pacific Islander groups.
Data from the United States National Cancer Database from 2004 to 2020 of 122,926 patients newly diagnosed with cervical cancer were retrospectively analyzed. Asian American, Native Hawaiian, or Pacific Islander patients were disaggregated by country of origin. Logistic regression, adjusted for clinical and sociodemographic factors, was used to calculate adjusted odds ratios. Higher adjusted odds ratios indicate an increased likelihood of metastatic versus nonmetastatic disease at diagnosis.
Out of 122,926 patients with cervical cancer, 5142 (4.2%) identified as Asian American, Native Hawaiian, or Pacific Islander. Compared to non-Hispanic White patients, pooled Asian American, Native Hawaiian, or Pacific Islander patients presented at lower stages of cancer (non-Hispanic White: 58.7% diagnosed local/regional, Asian American, Native Hawaiian, or Pacific Islander : 85.6% at local/regional, χ2 P<.001). The largest Asian American, Native Hawaiian, or Pacific Islander subgroups included Filipino Americans (n=1051, 20.4% of Asian American, Native Hawaiian, or Pacific Islander), Chinese Americans (n=995, 19.4%), Asian Indian/Pakistani Americans (n=711, 13.8%), Vietnamese Americans (n=627, 12.2%), and Korean Americans (n=550, 10.7%) respectively. Asian American, Native Hawaiian, or Pacific Islander disaggregation revealed that Pacific Islander American patients had higher odds of presenting with metastatic disease (adjusted odds ratio 1.58, 95% confidence interval 1.21-2.06, P=.001) relative to non-Hispanic White patients. Conversely, Chinese American (adjusted odds ratio 0.47, 95% confidence interval 0.37-0.59, P<.001), Vietnamese American (adjusted odds ratio 0.54, 95% confidence interval 0.41-0.70, P<.001), Hmong American (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.97, P=.040), and Indian/Pakistani American (adjusted odds ratio 0.76, 95% confidence interval 0.61-0.94, P=.013) patients were less likely to present with metastatic disease. Compared to the largest Asian American, Native Hawaiian, or Pacific Islander group (Chinese American), 9 other subgroups were more likely to present with metastatic disease. The largest differences were observed in Pacific Islander American (adjusted odds ratio 3.44, 95% confidence interval 2.41-4.91, P<.001), Thai American (adjusted odds ratio 2.79, 95% confidence interval 1.41-5.53, P=.003), Kampuchean American (adjusted odds ratio 2.39, 95% confidence interval 1.29-4.42, P=.006), Native Hawaiian American (adjusted odds ratio 2.23, 95% confidence interval 1.37-3.63, P=.001), and Laotian American (adjusted odds ratio 2.02, 95% confidence interval 1.13-3.61, P=.017). In contrast, Vietnamese American (adjusted odds ratio 1.20, 95% confidence interval 0.85-1.71, P=.303), and Hmong American (adjusted odds ratio 1.09, 95% confidence interval 0.50-2.37, P=.828) patients did not show a statistically significant difference in presenting with metastatic disease compared to Chinese American patients.
Aggregated evaluation of the Asian American, Native Hawaiian, or Pacific Islander monolith masks disparities in outcomes for distinct populations at risk for equity gaps. This disaggregation study shows that marginalized groups within the larger Asian American, Native Hawaiian, or Pacific Islander population-including Pacific Islander American and Thai American patients-may face different exposures and larger structural barriers to cancer screening and early-stage diagnosis. A future focus on community-based disaggregated research and tailored interventions is necessary to close these gaps.
2022年，超过2000万美国人被认定为亚裔美国人、夏威夷原住民或太平洋岛民。尽管亚裔美国人、夏威夷原住民或太平洋岛民社区内的移民历史、生活经历和健康需求存在多样性，但先前关于宫颈癌的研究将该群体作为一个整体来考虑。
我们试图分析美国宫颈癌确诊时的分期差异，重点关注细分后的亚裔美国人、夏威夷原住民或太平洋岛民群体。
对2004年至2020年美国国家癌症数据库中122926例新诊断为宫颈癌的患者数据进行回顾性分析。亚裔美国人、夏威夷原住民或太平洋岛民患者按原籍国进行细分。采用逻辑回归分析，并对临床和社会人口学因素进行校正，以计算校正后的比值比。校正后的比值比越高，表明诊断时转移性疾病与非转移性疾病的可能性增加。
在122926例宫颈癌患者中，5142例（4.2%）被认定为亚裔美国人、夏威夷原住民或太平洋岛民。与非西班牙裔白人患者相比，合并后的亚裔美国人、夏威夷原住民或太平洋岛民患者癌症分期较低（非西班牙裔白人：58.7%诊断为局部/区域期，亚裔美国人、夏威夷原住民或太平洋岛民：85.6%为局部/区域期，χ2检验P<.001）。最大的亚裔美国人、夏威夷原住民或太平洋岛民亚组分别包括菲律宾裔美国人（n = 1051，占亚裔美国人、夏威夷原住民或太平洋岛民的20.4%）、华裔美国人（n = 995，19.4%）、亚裔印度/巴基斯坦裔美国人（n = 711，13.8%）、越南裔美国人（n = 627，12.2%）和韩裔美国人（n = 550，10.7%）。按亚裔美国人、夏威夷原住民或太平洋岛民细分后发现，太平洋岛民裔美国患者出现转移性疾病的几率较高（校正后的比值比为1.58，95%置信区间为1.21 - 2.06，P =.001），相对于非西班牙裔白人患者。相反，华裔美国人（校正后的比值比为0.47，95%置信区间为0.37 - 0.59，P<.001）、越南裔美国人（校正后的比值比为0.54，95%置信区间为0.41 - 0.70，P<.001）、苗族裔美国人（校正后的比值比为0.46，95%置信区间为0.22 - 0.97，P =.040）和印度/巴基斯坦裔美国人（校正后的比值比为0.76，95%置信区间为0.61 - 0.94，P =.013）患者出现转移性疾病的可能性较小。与最大的亚裔美国人、夏威夷原住民或太平洋岛民群体（华裔美国人）相比，其他9个亚组出现转移性疾病的可能性更大。在太平洋岛民裔美国患者（校正后的比值比为3.44，95%置信区间为2.41 - 4.91，P<.001）、泰裔美国人（校正后的比值比为2.79，95%置信区间为1.41 - 5.53，P =.003）、柬埔寨裔美国人（校正后的比值比为2.39，95%置信区间为1.29 - 4.42，P =.006）、夏威夷原住民裔美国患者（校正后的比值比为2.23，95%置信区间为1.37 - 3.63，P =.001）和老挝裔美国患者（校正后的比值比为2.02，95%置信区间为1.13 - 3.61，P =.017）中观察到最大差异。相比之下，越南裔美国人（校正后的比值比为1.20，95%置信区间为0.85 - 1.71，P =.303）和苗族裔美国人（校正后的比值比为1.09，95%置信区间为0.50 - 2.37，P =.828）患者与华裔美国人患者相比，在出现转移性疾病方面没有统计学上的显著差异。
对亚裔美国人、夏威夷原住民或太平洋岛民整体的综合评估掩盖了不同风险人群在结果上的差异，这些人群存在公平差距。这项细分研究表明，在更大的亚裔美国人、夏威夷原住民或太平洋岛民群体中，被边缘化的群体——包括太平洋岛民裔美国人和泰裔美国人患者——在癌症筛查和早期诊断方面可能面临不同的暴露情况和更大的结构性障碍。未来有必要关注基于社区的细分研究和量身定制的干预措施，以缩小这些差距。
