Colorectal Cancer Outcomes Among Disaggregated Asian Subgroups: a 2006–2020 SEER Analysis

BACKGROUND: Despite varying colorectal cancer (CRC) outcomes across distinct Asian American subgroups, Asian individuals are often assessed in aggregate. We performed disaggregated analyses to assess for heterogeneity in CRC outcomes across the six largest Asian origin groups in the United States. METHODS: We identified adults with a primary diagnosis of CRC using surveillance, epidemiology, and end results (SEER) registry data from 2006 to 2020. Individuals from the six largest Asian origin groups and a referent non-Hispanic White (NHW) group were included. We identified predictors for regional or distant stage CRC at the time of diagnosis using multivariable logistic regression and predictors for CRC related death using multivariable Cox proportional hazards models. RESULTS: Our cohort included 25,379 Asian Americans, who identified as Chinese (6585 [25.9%]), Filipino (6399 [25.2%]), Japanese (4309 [17.0%]), Vietnamese (3047 [12.0%]), Korean (2964 [11.7%]), and Asian Indian/Pakistani (2075 [8.2%]), in addition to 234,938 NHW individuals. In our multivariable logistic regression, Vietnamese (aOR 1.23; 95% CI 1.14-1.32), Korean (aOR 1.20; 95% CI 1.11-1.30), and Asian Indian/Pakistani (aOR 1.10; 95% CI 1.01-1.21) individuals had increased odds of regional or distant stage at time of diagnosis compared to NHW individuals. In our multivariable Cox model, Chinese (aHR 0.92; 95% CI 0.88-0.97) and Asian Indian/Pakistani (aHR 0.88; 95% CI 0.80-0.97) individuals had decreased likelihood of CRC related death compared to NHW individuals. Lower neighborhood-level socioeconomic status by Yost Index was associated with worse CRC outcomes in both multivariable models. CONCLUSIONS: In this national cancer registry analysis, marked heterogeneity was observed in CRC stage and survival across disaggregated Asian American groups. Disaggregated analyses are key to accurately survey CRC trends, identify groups at highest risk, and develop culturally relevant approaches to CRC prevention and care.