Survival disparities in non-small cell lung cancer: Disaggregating Asians from NHPI and identifying variability among common Asian subgroups—The largest single-center study in Hawaiʻi.

225 Background: The American Cancer Society emphasize the need to disaggregate data for U.S. Asian, Native Hawaiian, and Other Pacific Islander (NHPI) populations to better understand racial disparities in cancer outcomes. This study analyzes non-small cell lung cancer (NSCLC) outcomes among Asian and NHPI populations. Methods: This retrospective cohort study identified NSCLC patients treated at Queen's Medical Center in Honolulu, Hawaiʻi (2000-2022). Patients were categorized into six racial/ethnic groups: White, Chinese, Japanese, Filipino, Other Asians, and NHPI. Kaplan-Meier analysis and Cox proportional hazards models evaluated survival differences. Results: The cohort comprised 4,160 patients, including 977 White, 419 Chinese, 968 Japanese, 724 Filipino, 217 Other Asians, and 855 NHPI patients. Median overall survival was 20.9 (18.3-23.5) months for Whites, 22.3 (17.8-26.9) months for Chinese, 17.7 (15.3-20.2) months for Japanese, 19.7 (16.1-23.3) months for Filipino, and 14.7 (12.0-17.3) months for NHPI (p<0.001). Asian NSCLC patients had a lower risk of death compared to White patients (adjusted HR 0.89, 95% CI 0.85-0.97, p=0.010). In contrast, NHPI patients had a higher risk of death compared to White patients (adjusted HR 1.15, 95% CI 1.03-1.28, p=0.011) in the multivariable analysis unadjusted for treatment. However, both associations were no longer statistically significant after additional adjustment for treatment. Subgroup analyses of Asian patients compared to Whites revealed that the Chinese had the lowest risk of death (adjusted HR 0.82, 95% CI 0.72-0.93, p=0.003). Conclusions: Our findings demonstrate the heterogeneity in NSCLC outcomes between U.S. Asians and NHPI patients as well as among individual Asian ethnic populations. While disparities in treatment may contribute to some observed differences, they do not fully explain the variations in outcomes. Univariable and multivariable analysis in all non-small cell lung cancer patients. Univariable analysis Multivariable analysis* Multivariable with treatment** HR (95%CI) P value HR (95%CI) P value HR (95%CI) P value Race White 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Asian 0.97 (0.89-1.06) 0.514 0.89 (0.82-0.97) 0.010 0.93 (0.85-1.01) 0.093 NHPI 1.18 (1.06-1.31) 0.002 1.15 (1.03-1.28) 0.011 1.06 (0.95-1.18) 0.313 Insurance Private 1.00 (Reference) 1.00 (Reference) 1.00 (Reference) Medicare 1.36 (1.26-1.47) <0.001 1.19 (1.10-1.30) <0.001 1.16 (1.07-1.26) <0.001 Medicaid/uninsured 1.38 (1.24-1.52) <0.001 1.26 (1.13-1.40) <0.001 1.10 (0.99-1.23) 0.074 *Multivariable analysis adjusted by race, age, gender, insurance, histology, stage. **Multivariable with treatment adjusted by race, age, gender, insurance, histology, stage, surgery, chemotherapy, immunotherapy, and radiation.