Neighborhood socioeconomic status in relation to mortality rates of gastrointestinal cancers among Asian American, Native Hawaiian, and Pacific Islander populations in California

Abstract Objective Gastrointestinal (GI) cancers account for approximately 24% of all cancer deaths in the United States (US). Demographic and socioeconomic status (SES) factors have been associated with mortality in GI cancers. However, the associations between GI cancer mortality and neighborhood SES (nSES) among non-Hispanic Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations in California have not been investigated. This study examined GI cancer mortality rates by nSES among AANHPI adults in California. Methods The California Cancer Registry, part of the population-based Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute, was used to identify AANHPI males and females who died of GI cancers from 2008 through 2012. GI cancer deaths were defined by the following sites: colorectum, stomach, esophagus, small intestine, and anus or anal canal. Each death was assigned a nSES index using the 2010 US Census data. Age-adjusted mortality rates of GI cancer and mortality rate ratios (MRR) as well as 95% confidence intervals by nSES quintiles were calculated for a 5-year period from 2008 through 2012. Subgroup analyses were conducted by sex and cancer site. Results A total of 5,153 cases were included in the final study population for analysis. Among all AANHPI males and females, those residing in the lowest nSES quintile had a 1.31-fold higher MRR of GI cancers compared to those in the highest nSES quintile (Q1 vs. Q5; 95% confidence interval (CI): 1.19–1.45). This positive association was observed in both males and females, although not statistically significant in females (males: nSES Q1 vs. Q5 MRR: 1.50; 95% CI: 1.31–1.71; females: nSES Q1 vs. Q5 MRR: 1.11; 95% CI: 0.96–1.29). Similar patterns of associations were seen across specific GI cancer sites. Conclusion AANHPI adults in California residing in lower nSES neighborhoods experienced higher GI cancer mortality compared with those in higher nSES areas. Future studies are needed to clarify the underlying mechanisms and identify actionable strategies to mitigate nSES-related inequities in GI cancer outcomes in the AANHPI population.