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Chin MK, Đoàn LN, Russo RG, Roberts T, Persaud S, Huang E, Fu L, Kui KY, Kwon SC, Yi SS. Methods for retrospectively improving race/ethnicity data quality: a scoping review. Epidemiol Rev 2023; 45:127-139. [PMID: 37045807 DOI: 10.1093/epirev/mxad002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/27/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Improving race and ethnicity (hereafter, race/ethnicity) data quality is imperative to ensure underserved populations are represented in data sets used to identify health disparities and inform health care policy. We performed a scoping review of methods that retrospectively improve race/ethnicity classification in secondary data sets. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were conducted in the MEDLINE, Embase, and Web of Science Core Collection databases in July 2022. A total of 2 441 abstracts were dually screened, 453 full-text articles were reviewed, and 120 articles were included. Study characteristics were extracted and described in a narrative analysis. Six main method types for improving race/ethnicity data were identified: expert review (n = 9; 8%), name lists (n = 27, 23%), name algorithms (n = 55, 46%), machine learning (n = 14, 12%), data linkage (n = 9, 8%), and other (n = 6, 5%). The main racial/ethnic groups targeted for classification were Asian (n = 56, 47%) and White (n = 51, 43%). Some form of validation evaluation was included in 86 articles (72%). We discuss the strengths and limitations of different method types and potential harms of identified methods. Innovative methods are needed to better identify racial/ethnic subgroups and further validation studies. Accurately collecting and reporting disaggregated data by race/ethnicity are critical to address the systematic missingness of relevant demographic data that can erroneously guide policymaking and hinder the effectiveness of health care practices and intervention.
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Affiliation(s)
- Matthew K Chin
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Lan N Đoàn
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Rienna G Russo
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Timothy Roberts
- NYU Langone Health Sciences Library, NYU Grossman School of Medicine New York, NY 10016, United States
| | - Sonia Persaud
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Department of Health Policy and Management, CUNY School of Public Health & Health Policy, New York, NY 10027, United States
| | - Emily Huang
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Lauren Fu
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Georgetown University, Washington DC 20007, United States
| | - Kiran Y Kui
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY 10032, United States
| | - Simona C Kwon
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
| | - Stella S Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States
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Khalifeh M, Goldfarb DG, Zeig-Owens R, Todd AC, Shapiro MZ, Carwile M, Dasaro CR, Li J, Yung J, Farfel MR, Brackbill RM, Cone JE, Qiao B, Schymura MJ, Prezant DJ, Hall C, Boffetta P. Cancer incidence in World Trade Center rescue and recovery workers by race and ethnicity. Am J Ind Med 2023; 66:1048-1055. [PMID: 37746817 DOI: 10.1002/ajim.23539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION It is unclear whether differences in health outcomes by racial and ethnic groups among World Trade Center (WTC) rescue and recovery workers reflect those of the population of New York State (NYS) or show distinct patterns. We assessed cancer incidence in WTC workers by self-reported race and ethnicity, and compared it to population figures for NYS. METHODS A total of 61,031 WTC workers enrolled between September 11, 2001 and January 10, 2012 were followed to December 31, 2015. To evaluate the association between race/ethnicity and cancer risk, Poisson regression analysis was used to estimate hazard ratios (HR) adjusted for WTC exposure, age, calendar year, sex and, for lung cancer, cigarette smoking. RESULTS In comparison to Whites, Black workers had a higher incidence of prostate cancer (HR = 1.99, 95% CI = 1.69-2.34) and multiple myeloma (HR = 3.57, 95% CI = 1.97-6.45), and a lower incidence of thyroid (HR = 0.41, 95% CI = 0.22-0.78) and colorectal cancer (HR = 0.57; 95% CI = 0.33-0.98). Hispanic workers had a higher incidence of liver cancer (HR = 4.03, 95% CI = 2.23-7.28). Compared with NYS population, White workers had significantly higher incidence of prostate cancer (HR = 1.26, 95% CI = 1.18-1.35) and thyroid cancer (HR = 1.80, 95% CI = 1.55-2.08), while Black workers had significantly higher incidence of prostate cancer (HR = 1.22, 95% CI = 1.05-1.40). CONCLUSION Cancer incidence in WTC workers generally reflects data from the NYS population, but some differences were identified that merit further investigation.
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Affiliation(s)
- Malak Khalifeh
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
| | - David G Goldfarb
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeline Carwile
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, Long Island City, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Charles Hall
- Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Fire Department of the City of New York, Brooklyn, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Ochoa-Allemant P, Tate JP, Williams EC, Gordon KS, Marconi VC, Bensley KM, Rentsch CT, Wang KH, Taddei TH, Justice AC. Enhanced Identification of Hispanic Ethnicity Using Clinical Data: A Study in the Largest Integrated United States Health Care System. Med Care 2023; 61:200-205. [PMID: 36893404 PMCID: PMC10114212 DOI: 10.1097/mlr.0000000000001824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Collection of accurate Hispanic ethnicity data is critical to evaluate disparities in health and health care. However, this information is often inconsistently recorded in electronic health record (EHR) data. OBJECTIVE To enhance capture of Hispanic ethnicity in the Veterans Affairs EHR and compare relative disparities in health and health care. METHODS We first developed an algorithm based on surname and country of birth. We then determined sensitivity and specificity using self-reported ethnicity from the 2012 Veterans Aging Cohort Study survey as the reference standard and compared this to the research triangle institute race variable from the Medicare administrative data. Finally, we compared demographic characteristics and age-adjusted and sex-adjusted prevalence of conditions in Hispanic patients among different identification methods in the Veterans Affairs EHR 2018-2019. RESULTS Our algorithm yielded higher sensitivity than either EHR-recorded ethnicity or the research triangle institute race variable. In 2018-2019, Hispanic patients identified by the algorithm were more likely to be older, had a race other than White, and foreign born. The prevalence of conditions was similar between EHR and algorithm ethnicity. Hispanic patients had higher prevalence of diabetes, gastric cancer, chronic liver disease, hepatocellular carcinoma, and human immunodeficiency virus than non-Hispanic White patients. Our approach evidenced significant differences in burden of disease among Hispanic subgroups by nativity status and country of birth. CONCLUSIONS We developed and validated an algorithm to supplement Hispanic ethnicity information using clinical data in the largest integrated US health care system. Our approach enabled clearer understanding of demographic characteristics and burden of disease in the Hispanic Veteran population.
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Affiliation(s)
| | - Janet P. Tate
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, USA
| | - Emily C. Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Services Research & Development, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Kirsha S. Gordon
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, USA
| | - Vincent C. Marconi
- Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | | | - Christopher T. Rentsch
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, USA
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Karen H. Wang
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, USA
| | - Tamar H. Taddei
- VA Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, USA
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Amy C. Justice
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, US Department of Veteran Affairs, West Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Alvarez CS, Petrick JL, Parisi D, McMahon BJ, Graubard BI, McGlynn KA. Racial/ethnic disparities in hepatocellular carcinoma incidence and mortality rates in the United States, 1992-2018. Hepatology 2022; 76:589-598. [PMID: 35124828 PMCID: PMC9352816 DOI: 10.1002/hep.32394] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS HCC is characterized by racial/ethnic disparities in rates. Recent USA reports suggest that incidence has begun to decline, but it is not clear whether the declines have occurred among all groups, nor whether mortality has declined. Thus, the current study examined USA incidence and mortality between 1992 and 2018. APPROACH & RESULTS HCC incidence and incidence-based mortality data from the Surveillance, Epidemiology, and End Results program were used to calculate age-standardized rates by race/ethnicity, sex, and age. Trends were analyzed using joinpoint regression to estimate annual percent change (APC). Age-period-cohort models assessed the effects on trends of age, calendar period, and birth cohort. Overall, HCC incidence significantly declined between 2015 and 2018 (APC, -5.6%). Whereas most groups experienced incidence declines, the trends were most evident among Asians/Pacific Islanders, women, and persons <50 years old. Exceptions were the rates among non-Hispanic Black persons, which did not significantly decline (APC, -0.7), and among American Indians/Alaska Natives, which significantly increased (APC, +4.3%). Age-period-cohort modeling found that birth cohort had a greater effect on rates than calendar period. Among the baby boom cohorts, the 1950-1954 cohort had the highest rates. Similar to the overall incidence decline, HCC mortality rates declined between 2013 and 2018 (APC, -2.2%). CONCLUSIONS HCC incidence and mortality rates began to decline for most groups in 2015, but persistent differences in rates continued to exist. Rates among non-Hispanic Black persons did not decline significantly, and rates among American Indians/Alaska Natives significantly increased, suggesting that greater effort is needed to reduce the HCC burden among these vulnerable groups.
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Affiliation(s)
- Christian S. Alvarez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | | | | | - Brian J. McMahon
- Liver Diseases and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK
| | - Barry I. Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Katherine A. McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Disparities in trial enrollment and outcomes of Hispanic adolescent and young adult acute lymphoblastic leukemia. Blood Adv 2022; 6:4085-4092. [PMID: 35838753 PMCID: PMC9327550 DOI: 10.1182/bloodadvances.2022007197] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Contrary to population data, survival of Hispanic AYA ALL patients enrolled on CALGB 10403 was equivalent to non-Hispanic patients. Geographical alignment between Hispanic patient incidence and trial sites may increase Hispanic patient enrollment onto clinical trials.
In this secondary analysis of Hispanic adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) treated on Cancer and Leukemia Group B (CALGB) 10403, we evaluated outcomes and geographic enrollment patterns relative to US population data. We used demographic, clinical, and survival data on AYAs enrolled on CALGB 10403 (N = 295, 2007-2012). Surveillance, Epidemiology, and End Results registries provided overall survival (OS) for US AYA ALL by ethnicity/race. North American Association of Cancer Registries provided AYA ALL incidence overall and proportion among Hispanics by US state. Of AYAs enrolled on CALGB 10403, 263 (89%) reported ethnicity/race: 45 (17%) Hispanic, 172 (65%) non-Hispanic White (NHW), 25 (10%) non-Hispanic Black (NHB), and 21 (8%) other. Compared with NHWs, Hispanic and NHB patients had lower household income, and Hispanic patients were more likely to harbor high-risk CRLF2 aberrations. Relative to US estimates, where Hispanic patients represented 46% of newly diagnosed AYA ALL patients and experienced inferior OS compared with NHW (P < .001), Hispanic AYAs on CALGB 10403 did as well as NHW patients (3 year OS, 75% vs 74%; P = NS). Hispanic patients also had higher rates of protocol completion (P = .05). Enrollments on CALGB 10403 differed relative to the distribution of Hispanic AYA ALL in the United States: enrollment was highest in the Midwest; t and only 15% of enrollees were from states with a high proportion of Hispanic AYA ALL patients. In summary, Hispanic patients treated on CALGB 10403 did as well as NHWs and better than population estimates. Geographical misalignment between trial sites and disease epidemiology may partially explain the lower-than-expected enrollment of Hispanic AYA ALL patients.
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Pinheiro LC, Soroka O, Kern LM, Leonard JP, Safford MM. Racial Disparities in Diabetes-Related Emergency Department Visits and Hospitalizations Among Cancer Survivors. JCO Oncol Pract 2022; 18:e1023-e1033. [PMID: 35133858 PMCID: PMC9797245 DOI: 10.1200/op.21.00684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Black and Hispanic individuals with diabetes receive less recommended diabetes care after cancer diagnosis than non-Hispanic Whites (NHW). We sought to determine whether racial/ethnic minorities with diabetes and cancer were at increased risk of diabetes-related emergency department (ED) visits and hospitalizations compared with NHW. METHODS Using SEER cancer registry data linked to Medicare claims from 2006 to 2014, we included Medicare beneficiaries age 66+ years diagnosed with incident nonmetastatic breast, prostate, or colorectal cancer between 2007 and 2012 who had diabetes. Our primary outcome was any diabetes-related ED visit or hospitalization 366-731 days after cancer diagnosis. Using Fine-Gray subdistribution hazard models, we examined whether risk of ED visits or hospitalizations was higher for racial/ethnic minorities compared with NHW. RESULTS We included 40,059 beneficiaries with mean age 75.5 years (standard deviation 6.3), 45.6% were women, and 28.9% were non-White. Overall, 825 (2.1%) had an ED visit and 3,324 (8.3%) had a hospitalization related to diabetes in the 366-731 days after cancer diagnosis. Compared with NHW, Black individuals were more likely to have ED visits (2.9% v 2.0%; P < .0001) and hospitalizations (11.7% v 7.8%; P < .0001). Adjusting for potential confounders, Black (adjusted hazard ratio, 1.22; 95% CI, 1.12 to 1.35) individuals had a higher risk of any ED visit or hospitalization compared with NHW. CONCLUSION Black individuals with diabetes and cancer were at increased risk for diabetes-related ED visits and hospitalizations in the second year after cancer diagnosis compared with NHW even after accounting for confounders.
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Affiliation(s)
- Laura C. Pinheiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY,Laura C. Pinheiro, PhD, MPH, Division of General Internal Medicine Weill Cornell Medicine, 420 East 70th St, 3rd Floor (LH359), New York, NY 10021; e-mail:
| | - Orysya Soroka
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Lisa M. Kern
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - John P. Leonard
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
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Zhu C, Weiss M, Scribbick FW, Johnson DA, Kheirkhah A. Occurrence of Occult Neoplasia in Pterygium Specimens among Hispanic and Non-Hispanic Patients. Curr Eye Res 2022; 47:978-981. [PMID: 35180019 DOI: 10.1080/02713683.2022.2035403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia (OSSN) in pterygium specimens. METHODS This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of OSSN were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult OSSN in pterygium specimens. RESULTS There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 71% and non-Hispanic in 29%. Among all specimens, 18 (3.6%) were positive for occult OSSN. The prevalence of occult OSSN in pterygium specimens was higher in Hispanics compared to Non-Hispanics (4.8% versus 0.7%, respectively, P = 0.025). The prevalence of occult OSSN in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (P = 0.57). There were also no statistically significant differences between those with or without occult OSSN regarding age or sex. CONCLUSIONS A significant but low rate of occult OSSN was found in pterygium specimens. The percentage of those with OSSN in pterygium specimens was significantly greater in Hispanics compared to Non-Hispanics. As treatment and prognosis of pterygium and OSSN differ, histopathologic evaluation of all pterygium specimens is warranted.
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Affiliation(s)
- Christopher Zhu
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Menachem Weiss
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Frank W Scribbick
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
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Li J, Yung J, Qiao B, Takemoto E, Goldfarb DG, Zeig-Owens R, Cone JE, Brackbill RM, Farfel MR, Kahn AR, Schymura MJ, Shapiro MZ, Dasaro CR, Todd AC, Kristjansson D, Prezant DJ, Boffetta P, Hall CB. Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up. J Natl Cancer Inst 2022; 114:210-219. [PMID: 34498043 PMCID: PMC8826586 DOI: 10.1093/jnci/djab165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Statistically significantly increased cancer incidence has been reported from 3 cohorts of World Trade Center (WTC) disaster rescue and recovery workers. We pooled data across these cohorts to address ongoing public concerns regarding cancer risk 14 years after WTC exposure. METHODS From a combined deduplicated cohort of 69 102 WTC rescue and recovery workers, a sample of 57 402 workers enrolled before 2009 and followed through 2015 was studied. Invasive cancers diagnosed in 2002-2015 were identified from 13 state cancer registries. Standardized incidence ratios (SIRs) were used to assess cancer incidence. Adjusted hazard ratios (aHRs) were estimated from Cox regression to examine associations between WTC exposures and cancer risk. RESULTS Of the 3611 incident cancers identified, 3236 were reported as first-time primary (FP) cancers, with an accumulated 649 724 and 624 620 person-years of follow-up, respectively. Incidence for combined FP cancers was below expectation (SIR = 0.96, 95% confidence interval [CI] = 0.93 to 0.99). Statistically significantly elevated SIRs were observed for melanoma-skin (SIR = 1.43, 95% CI = 1.24 to 1.64), prostate (SIR = 1.19, 95% CI = 1.11 to 1.26), thyroid (SIR = 1.81, 95% CI = 1.57 to 2.09), and tonsil (SIR = 1.40, 95% CI = 1.00 to 1.91) cancer. Those arriving on September 11 had statistically significantly higher aHRs than those arriving after September 17, 2001, for prostate (aHR = 1.61, 95% CI = 1.33 to 1.95) and thyroid (aHR = 1.77, 95% CI = 1.11 to 2.81) cancers, with a statistically significant exposure-response trend for both. CONCLUSIONS In the largest cohort of 9/11 rescue and recovery workers ever studied, overall cancer incidence was lower than expected, and intensity of WTC exposure was associated with increased risk for specific cancer sites, demonstrating the value of long-term follow-up studies after environmental disasters.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Erin Takemoto
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - David G Goldfarb
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - James E Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, NY, USA
| | - Amy R Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Maria J Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, NY, USA
| | - Moshe Z Shapiro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher R Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
| | - David J Prezant
- Fire Department of the City of New York (FDNY), Brooklyn, NY, USA
- Department of Medicine, Montefiore Medical Center, New York, NY, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Paolo Boffetta
- Medicine Department of Family, Population and Preventive Medicine Health Sciences, Stony Brook University, Stony Brook Cancer Center, Stony Brook, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Racial disparities in diabetes care among incident breast, prostate, and colorectal cancer survivors: a SEER Medicare study. J Cancer Surviv 2022; 16:52-60. [PMID: 33661509 PMCID: PMC9789687 DOI: 10.1007/s11764-021-01003-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many cancer survivors with co-morbid diabetes receive less diabetes management than their non-cancer counterparts. We sought to determine if racial/ethnic disparities exist in recommended diabetes care within 12 months of an incident breast, prostate, or colorectal cancer diagnosis. Because co-morbid diabetes decreases long-term survival, identifying predictors of guideline-concordant diabetes care is important. METHODS Using the Surveillance, Epidemiology, and End Results cancer registry linked to Medicare claims, we included beneficiaries aged 67+ years with diabetes and incident, non-metastatic breast, prostate, or colorectal cancer between 2008 and 2013. Primary outcomes were diabetes care services 12 months after diagnosis: (1) HbA1c test, (2) eye exam, and (3) low-density lipoprotein (LDL) test. Using modified Poisson models with robust standard errors, we examined each outcome separately. RESULTS We included 34,643 Medicare beneficiaries with both diabetes and cancer. Mean age at diagnosis was 76.1 (SD 6.2), 47.2% were women; 35% had breast, 24% colorectal, and 41% prostate cancer. In the 12 months after incident cancer diagnosis, 82.4% received an HbA1c test, 55.3% received an eye exam, 77.8% had an LDL test, and 42.0% received all three tests. Compared to non-Hispanic Whites, Blacks were 3% (95% CI 0.95-0.98) less likely to receive a HbA1c test, 10% (95% CI 0.89-0.92) less likely to receive a LDL test, and 8% (95% 0.89-0.95) less likely to receive an exam eye. Blacks and Hispanics were 16% (95% CI 0.81-0.88) and 7% (0.88-0.98) less likely to receive all three tests, after accounting for confounders. Racial/ethnic differences persisted across cancer types. CONCLUSION Blacks and Hispanics with breast, prostate, and colorectal cancer and diabetes received less diabetes care after cancer diagnosis compared to non-Hispanic Whites. Differences were not explained by socio-economic factors or clinical need. IMPLICATIONS FOR CANCER SURVIVORS Our findings are concerning given the high prevalence of diabetes and poor cancer outcomes among racial/ethnic minorities. The next step in this line of inquiry is to determine why minorities are less likely to receive comprehensive diabetes care in order to develop targeted strategies to increase receipt of appropriate diabetes management for these vulnerable populations.
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Quiroz E, Venkateswaran AR, Nelson R, Aldoss I, Pullarkat V, Rego E, Marcucci G, Douer D. Immunophenotype of acute lymphoblastic leukemia in minorities- analysis from the SEER database. Hematol Oncol 2021; 40:105-110. [PMID: 34766363 DOI: 10.1002/hon.2945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/07/2022]
Abstract
Acute Lymphocytic Leukemia (ALL) is a malignancy that originates from immature lymphoid cells and is clinically established with flow cytometry through disease-specific markers. Variation between ethnic groups is an epidemiological aspect of ALL. Higher incidence rates have been observed in Latin American patients and ALL in Latinos carries a dismal prognosis. The cell of origin in ALL is derived from immature cells of either the B or T lineage. Most reported data among Latinos either exclusively looks at B cell precursor ALL or do not distinguish between subtypes. We used the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database to delineate the differences in incidence rates of B-ALL and T-ALL across ethnic groups in the United States. Data from SEER-18 was used to compare incidence rates of T-ALL and B-ALL. Due to the utilization of cytogenetics and subsequent changes in ICD coding over the years examined the most recent data reported from 2002 to 2017. We compared rates in Non-Hispanic Whites (NHWs), Latinos, Blacks and Asian-Pacific Islanders (API). Age-adjusted incidence rates per 100,000 person-years were calculated. The incidence rate of B-ALL in the Latino population was consistently higher than other race/ethnicities throughout the years, ranging from 1.0 per 100,000 in 2002 to 2.5 per 100,000 in 2017. Blacks had the lowest age adjusted incidence rate (AAIR) of B-ALL overall, with rates approximately one third of those found in Latinos and the highest AAIR of T-ALL with an AAIR of 0.5 per 100,000.
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Affiliation(s)
| | | | | | | | | | | | | | - Dan Douer
- University of Southern California, Los Angeles, California, USA
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Chawla S, Chawla A, Hussain M, Karimuddin AA, Khosa F. The State of Diversity in Academic Plastic Surgery Faculty across North America. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3928. [PMID: 34796084 PMCID: PMC8594659 DOI: 10.1097/gox.0000000000003928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gender and racial disparity is prevalent in all surgical subspecialties with women and racial groups historically underrepresented in academic plastic surgery. This study evaluated gender and racial profiles of academic plastic surgery faculty in North America and correlated both with research productivity and its effect on academic ranks of faculty in plastic surgery. METHODS In this cross-sectional study, we compiled a list of accredited medical schools that offer plastic surgery training for residency. Data were collected on demographics, academic rank, and research output using the Doximity, LinkedIn, and Scopus databases. Data analyses were performed with a Mann-Whitney U test and a Kruskal-Wallis test. RESULTS Women who were black, indigenous, and/or other color occupied only 6.25% of plastic surgery faculty leadership positions in North America. There are more women and underrepresented minorities in leadership positions in Canada, when compared with the USA, relative to each country's demographic. In both countries, women and underrepresented minority plastic surgeons had fewer publications, citations, and years of active research. Interestingly, having women in leadership positions was associated with a higher number of women faculty members. CONCLUSIONS Gender and racial disparity exist in academic plastic surgery in North America. Several changes are required in order for women and underrepresented minorities in medicine to have an equal chance at career advancement. Better representation and diverse leadership have the potential to bring about equity, diversity, and inclusion in academic plastic surgery.
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Affiliation(s)
- Sahil Chawla
- From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Amey Chawla
- The University of the Fraser Valley, Abbotsford, British Columbia
| | - Mehwish Hussain
- College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ahmer A. Karimuddin
- Department of Surgery, University of British Columbia; Vancouver, British Columbia
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital; Vancouver, British Columbia
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12
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Petrick JL, Barber LE, Warren Andersen S, Florio AA, Palmer JR, Rosenberg L. Racial Disparities and Sex Differences in Early- and Late-Onset Colorectal Cancer Incidence, 2001-2018. Front Oncol 2021; 11:734998. [PMID: 34568072 PMCID: PMC8459723 DOI: 10.3389/fonc.2021.734998] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/09/2021] [Indexed: 12/17/2022] Open
Abstract
Background Colorectal cancer (CRC) incidence rates have increased in younger individuals worldwide. We examined the most recent early- and late-onset CRC rates for the US. Methods Age-standardized incidence rates (ASIR, per 100,000) of CRC were calculated using the US Cancer Statistics Database’s high-quality population-based cancer registry data from the entire US population. Results were cross-classified by age (20-49 [early-onset] and 50-74 years [late-onset]), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, American Indian/Alaskan Native, Asian/Pacific Islander), sex, anatomic location (proximal, distal, rectal), and histology (adenocarcinoma, neuroendocrine). Results During 2001 through 2018, early-onset CRC rates significantly increased among American Indians/Alaskan Natives, Hispanics, and Whites. Compared to Whites, early-onset CRC rates are now 21% higher in American Indians/Alaskan Natives and 6% higher in Blacks. Rates of early-onset colorectal neuroendocrine tumors have increased in Whites, Blacks, and Hispanics; early-onset colorectal neuroendocrine tumor rates are 2-times higher in Blacks compared to Whites. Late-onset colorectal adenocarcinoma rates are decreasing, while late-onset colorectal neuroendocrine tumor rates are increasing, in all racial/ethnic groups. Late-onset CRC rates remain 29% higher in Blacks and 15% higher in American Indians/Alaskan Natives compared to Whites. Overall, CRC incidence was higher in men than women, but incidence of early-onset distal colon cancer was higher in women. Conclusions The early-onset CRC disparity between Blacks and Whites has decreased, due to increasing rates in Whites—rates in Blacks have remained stable. However, rates of colorectal neuroendocrine tumors are increasing in Blacks. Blacks and American Indians/Alaskan Natives have the highest rates of both early- and late-onset CRC. Impact Ongoing prevention efforts must ensure access to and uptake of CRC screening for Blacks and American Indians/Alaskan Natives.
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Affiliation(s)
- Jessica L Petrick
- Slone Epidemiology Center at Boston University, Boston, MA, United States
| | - Lauren E Barber
- Slone Epidemiology Center at Boston University, Boston, MA, United States.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Shaneda Warren Andersen
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Cancer Prevention and Control, University of Wisconsin Carbone Cancer Center, Madison, WI, United States
| | - Andrea A Florio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, United States
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, United States
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Abstract
BACKGROUND The impact of residency training on academic productivity and a career in academic plastic surgery remains uncertain. Previous literature has explored the influence of training institutions on academic careers in surgery. The aims of the study were to assess research productivity during plastic surgery residency training and to illustrate how differences in training programs impact resident research productivity. METHODS Academic plastic surgery faculty that graduated in the past 10 years were identified through an Internet search of all Accreditation Council for Graduate Medical Education-accredited residency and fellowship training programs. Research productivity was compared based on h-index, number, and quality of peer-reviewed articles published during residency. RESULTS Three hundred seventy-five academic plastic surgeons were identified and produced 2487 publications during residency. The 10 most productive training institutions were Johns Hopkins, Georgetown, University of Michigan, Stanford, University of California Los Angeles, Northwestern, Harvard, New York University, University of Pennsylvania, and Baylor. Academic productivity was higher among integrated residents (integrated = 8.68 publications, independent = 5.49 publications, P < 0.0001). The number of publications positively correlated to faculty size (r = 0.167, P = 0.0013), National Institute of Health (NIH) funding (r = 0.249, P < 0.0001), residency graduation year (r = 0.211, P < 0.0001), and negatively correlated with Doximity ranking (r = -0.294, P < 0.0001). H-index was positively correlated with number of publications (r = 0.622, P < 0.0001), faculty size (r = 0.295, P < 0.0001), and NIH funding (r = 0.256, P < 0.0001) and negatively correlated with Doximity ranking (r = -0.405, P < 0.0001) and residency graduation year (r = -0.163, P < 0.0001). CONCLUSIONS Our study has found that there is an elite cohort of programs that are the most productive research institutions. Resident research productivity is higher among integrated residents, recent graduates, and programs that are larger in size, with a higher Doximity ranking and NIH funding. This study can guide medical students and future applicants who are interested in a career in academic plastic surgery in the selection of programs that match their career aspirations.
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Change Is Happening: An Evaluation of Gender Disparities in Academic Plastic Surgery. Plast Reconstr Surg 2020; 144:1001-1009. [PMID: 31568320 DOI: 10.1097/prs.0000000000006086] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender disparities in academic plastic surgery are known; however, recently, professional societies have endorsed a culture of gender diversification. This study aims to evaluate the effects of these changes at faculty and leadership positions. METHODS A cross-sectional study was conducted in June of 2018 to evaluate gender representation among U.S. academic plastic surgery faculty, and compare career qualifications, years of experience, and faculty positions. RESULTS A total of 938 academic plastic surgeons were identified, of which only 19.8 percent were women. Female surgeons graduated more recently than men (2009 versus 2004; p < 0.0001) and predominantly from integrated residency programs (OR, 2.72; 95 percent CI, 1.87 to 3.96), were more likely to be an assistant professor (OR, 2.19; 95 percent CI, 1.58 to 3.05), and were less likely to be a full professor (OR, 0.20; 95 percent CI, 0.11 to 0.35) or program chair (OR, 0.32; 95 percent CI, 0.16 to 0.65). After adjustment for differences in years of postresidency experience, only disparities at the full professor position remained significant (OR, 0.34; 95 percent CI, 0.16 to 0.17), indicating that experience-independent gender inequality is prominent at the full professor level and that current differences in cohort experience are a significant contributor to many of the observed positional disparities. Lastly, programs led by a female chair employed significantly more female faculty (32.5 percent versus 18.2 percent; p = 0.016). CONCLUSIONS Gender diversity in academic plastic surgery remains a significant issue, but may see improvement as the disproportionately high number of junior female academics advance in their careers. However, leadership and promotion disparities between men and women still exist and must be addressed.
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Quiroz E, Aldoss I, Pullarkat V, Rego E, Marcucci G, Douer D. The emerging story of acute lymphoblastic leukemia among the Latin American population - biological and clinical implications. Blood Rev 2018; 33:98-105. [PMID: 30126753 DOI: 10.1016/j.blre.2018.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2018] [Accepted: 08/10/2018] [Indexed: 12/20/2022]
Abstract
Higher incidence rates and poor outcomes have been reported among Latin American patients (Latinos) with acute lymphoblastic leukemia (ALL). Distinct patterns in recent genomic studies allude to a predisposing genetic component. In this review, we critically examine the increasing amount of empirical information on the epidemiology, outcomes and genomics of Latinos with ALL. We discuss the immense diversity within the Latino community and varying definitions of what is considered Latino, which pose an epidemiological challenge. Environmental factors have been evaluated as possible predisposing factors in the development of ALL but studies have produced conflicting results. In this review we describe chromosomal abnormalities and the specific genomic landscape in Latinos with ALL and their association with unfavorable prognosis, focusing on the higher frequency of Philadelphia chromosome-Like ALL. Recent data suggest an association between polymorphisms that are commonly found in indigenous Americans and high rates of ALL. The review compares the distribution of ALL throughout the various countries in Latin America in an attempt to shed some epidemiological light on the genetic ancestry of ALL. We additionally identify areas where research is warranted in efforts toward the advent of novel targeted agents that are relevant in improving outcomes within the Latino community.
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Affiliation(s)
| | | | | | | | | | - Dan Douer
- University of Southern California, Los Angeles, CA, USA
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Pinheiro LC, Check DK, Rosenstein D, Reeder-Hayes KE, Dusetzina S. Examining potential gaps in supportive medication use for US and foreign-born Hispanic women with breast cancer. Support Care Cancer 2018; 27:1639-1646. [DOI: 10.1007/s00520-018-4406-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/03/2018] [Indexed: 02/02/2023]
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Chinea FM, Patel VN, Kwon D, Lamichhane N, Lopez C, Punnen S, Kobetz EN, Abramowitz MC, Pollack A. Ethnic heterogeneity and prostate cancer mortality in Hispanic/Latino men: a population-based study. Oncotarget 2017; 8:69709-69721. [PMID: 29050235 PMCID: PMC5642510 DOI: 10.18632/oncotarget.19068] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/03/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Few studies focus on prostate cancer (PCa) outcomes in Hispanic/Latino men. Our study explores whether Hispanic/Latino subgroups demonstrate significantly different prostate cancer-specific mortality (PCSM) relative to Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) men. METHODS We extracted a population-based cohort of men diagnosed with local-regional PCa from 2000-2013 (n= 486,865). PCSM was measured in racial/ethnic groups: NHW (n=352,886), NHB (n= 70,983), Hispanic/Latino (n= 40,462), and Asian American/Pacific Islander (n= 22,534). PCSM was also measured in Hispanic/Latino subgroups: Mexican (n= 8,077), Puerto Rican (n= 1,284), South or Central American (n= 3,021), Cuban (n= 788), and Dominican (n= 300). We conducted univariable and multivariable analyses (MVA) to compare risk for PCSM. RESULTS Compared to NHW men, results showed worse outcomes for NHB men with similar outcomes for Hispanic/Latino men. In MVA with NHW men as a reference, NHB (HR= 1.15, p <0.001) men had significantly worse PCSM and Hispanic/Latino (HR= 1.02, p= 0.534) men did not show a significant difference. In a second MVA, Puerto Rican (HR= 1.71, p <0.001) and Mexican (HR= 1.21, p= 0.008) men had significantly higher PCSM. With NHB men as a reference, the MVA showed Puerto Rican (HR= 1.50, p= 0.006) men with higher PCSM and Mexican (HR= 1.08, p= 0.307) men with no significant difference. CONCLUSIONS Our findings indicate previously unknown disparities in PCSM for Puerto Rican and Mexican American men.
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Affiliation(s)
- Felix M. Chinea
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Vivek N. Patel
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Deukwoo Kwon
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Narottam Lamichhane
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Chris Lopez
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Sanoj Punnen
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Department of Urology, University of Miami, Miami, FL, USA
| | - Erin N. Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
- Division of Population Health and Computational Medicine, Department of Medicine, University of Miami, Miami, FL, USA
| | - Matthew C. Abramowitz
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Petrick JL, Kelly SP, Altekruse SF, McGlynn KA, Rosenberg PS. Future of Hepatocellular Carcinoma Incidence in the United States Forecast Through 2030. J Clin Oncol 2016; 34:1787-94. [PMID: 27044939 PMCID: PMC4966339 DOI: 10.1200/jco.2015.64.7412] [Citation(s) in RCA: 318] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hepatocellular carcinoma (HCC) incidence rates have been increasing in the United States for the past 35 years. Because HCC has a poor prognosis, quantitative forecasts could help to inform prevention and treatment strategies to reduce the incidence and burden of HCC. METHODS Single-year HCC incident case and population data for the years 2000 to 2012 and ages 35 to 84 years were obtained from the SEER 18 Registry Database. We forecast incident HCC cases through 2030, using novel age-period-cohort models and stratifying by sex, race/ethnicity, and age. Rates are presented because absolute numbers may be influenced by population increases. RESULTS Rates of HCC increased with each successive birth cohort through 1959. However, rates began to decrease with the 1960 to 1969 birth cohorts. Asians/Pacific Islanders (APIs) have had the highest HCC rates in the United States for many years, but the rates have stabilized and begun to decline in recent years. Between 2013 and 2030, rates among APIs are forecast to decline further, with estimated annual percentage changes of -1.59% among men and -2.20% among women. Thus, by 2030, Asians are forecast to have the lowest incidence rates among men, and Hispanics are forecast to have the highest rates among men (age-standardized rate, 44.2). Blacks are forecast to have the highest rate among women (age-standardized rate, 12.82). CONCLUSION Although liver cancer has long had some of the most rapidly increasing incidence rates, the decreasing rates seen among APIs, individuals younger than 65 years, and cohorts born after 1960 suggest that there will be declines in incidence of HCC in future years. Prevention efforts should be focused on individuals in the 1950 to 1959 birth cohorts, Hispanics, and blacks.
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Affiliation(s)
| | - Scott P Kelly
- All authors: National Cancer Institute, Bethesda, MD
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