Unmasking inequalities in gastrointestinal cancer outcomes among Asian American subpopulations

Globally, gastrointestinal (GI) cancer burden is higher in Asian populations. Asian Americans are commonly aggregated into a single category, potentially masking disparities. This study compared mortality from GI cancers among Asian American subpopulations to White patients. Mortality data (2018–2023) was collected from Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research which included White and Asian subgroups: Indian Americans, Chinese, Filipino, Japanese, Korean, and Vietnamese. Deaths from all causes and GI cancers (esophagus, stomach, small intestine, colon, rectal, anal, hepatobiliary, and pancreas) were analyzed. Proportional mortality (PM) was calculated as cancer deaths divided by all deaths. During the study period, there were 425,162 total deaths and 34,167 deaths from GI cancers among the Asian American population in the United states, compared to 14,066,027 total deaths and 713,638 deaths from GI cancers among the White population (PM 8.0% vs. 5.1%, p < 0.001). Among Asian American women, the largest disparities in PM were observed in patients with stomach (1.0% vs. 0.2%, p < 0.001) and hepatobiliary cancers (1.7% vs. 0.7%), p < 0.001) relative to White women. Similarly, among Asian American men, the largest disparities were also observed in stomach (1.1% vs. 0.3%, p < 0.001) and hepatobiliary cancers (2.7% vs. 1.1%, p < 0.001). Anal cancers was the only GI cancer for which Asian American women (0.02% vs. 0.07%) and men (0.02% vs. 0.04%) had lower PMs compared to the White population. Asian Americans experience greater mortality from GI cancers compared to white patients. The largest differences in PM were observed in stomach and hepatobiliary cancers across both male and female populations and all age categories. Culturally competent strategies that tailor screening guidelines and cancer prevention efforts to the unique risk profiles of Asian American subpopulations are desperately needed.