Disparities in non-small cell lung cancer among disaggregated Asian American, Native Hawaiian, and Pacific Islander subgroups.

155 Background: Aggregation of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) data masks health disparities. We identified differences in age at diagnosis, stage at presentation, and treatment status among disaggregated AANHPI patients with non-small cell lung cancer (NSCLC). Methods: 2004-2021 data from the National Cancer Database was used to identify patients with NSCLC. AANHPI patients were disaggregated by racial subgroup: Chinese, Japanese, Filipino, Hawaiian, Korean, Vietnamese, Laotian, Hmong, Kampuchean, Thai, Asian Indian or Pakistani, Asian Indian, Pakistani, Pacific Islander, and Other Asian. Multivariable logistic regression models were used to define adjusted odds ratios (aORs) with 95% CI of age at diagnosis, stage IV disease presentation, and treatment receipt. Results: Among 1,631,905 patients with NSCLC, 48,915 (3%) were AANHPI. AANHPI patients were more likely to be diagnosed between ages 18-49 (AANHPI 5.91% vs. White 3.28%, aOR=2.12, 95%CI = 2.03-2.21, p<0.001), present with stage IV disease (50.61% vs 39.92%, aOR=1.40, 95%CI = 1.37-1.43, p<0.001), have adenocarcinoma (72.44% vs 54.15%); and equally likely to receive treatment (87.03% vs 87.81%, aOR=0.98, 95%CI = 0.95-1.01, p=0.165) compared to White patients. Compared to White patients, Japanese patients (aOR=0.64, 95%CI = 0.50-0.82, p<0.001) were less likely to be diagnosed between ages 18-49 while all other AANHPI subgroups were more likely to be diagnosed between ages 18-49 with Hmong (aOR=5.65, 95%CI = 3.37-9.47, p<0.001), Laotian (aOR=3.76, 95%CI = 2.76-5.13, p<0.001), Vietnamese (aOR=3.16, 95%CI = 2.85-3.49, p<0.001), and Thai (aOR=3.01, 95%CI = 2.12-4.26, p<0.001) patients at least three times more likely. Aside from Hawaiian patients, all AANHPI subgroups had greater odds of presenting with stage IV disease when compared to White patients with Hmong (aOR=2.78, 95%CI 1.88-4.09, p<0.001) and Laotian (aOR=2.43, 95%CI = 1.99-2.97, p<0.001) patients with the greatest odds. Compared to White patients, Asian Indian or Pakistani (aOR=1.25, 95%CI = 1.07-1.45, p=0.005) were more likely to receive treatment while Hmong (aOR=0.41, 95%CI = 0.25-0.66, p<0.001), Laotian (aOR=0.70, 95%CI = 0.53-0.94, p=0.016), Vietnamese (aOR=0.81, 95%CI = 0.74-0.88, p<0.001), Kampuchean (aOR=0.74, 95%CI = 0.55--1.00, p=0.049), and Pacific Islander (aOR=0.78, 95%CI = 0.65-0.92, p=0.004) patients were less likely to receive treatment. Conclusions: AANHPI patients were more likely to be diagnosed with young onset NSCLC, stage IV disease, and equally likely to receive treatment. However, Hmong and Laotian patients were the least likely to receive treatment and most likely to be diagnosed young and with stage IV disease. Many other AANHPI subgroups demonstrate significant disparities. Further disaggregation of AANHPI data will be essential in battling lung cancer disparities.