Burdens of Gastroenteropancreatic Neuroendocrine Neoplasm by Diverse Race and Ethnicities— A Rigorous Structural Equation Modeling
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
Search for other papers by Alan Paciorek in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Claire Mulvey in
Current site
Google Scholar
PubMed
Search for other papers by Meg McKinley in
Current site
Google Scholar
PubMed
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Li Zhang in
Current site
Google Scholar
PubMed
Search for other papers by Iona Cheng in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Farhana Moon in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Bryan Khuong Le in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Brandon E. Shih in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Now with RTI International, Research Triangle Park, NC
Search for other papers by Julia Whitman in
Current site
Google Scholar
PubMed
Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
Search for other papers by Emily Bergsland in
Current site
Google Scholar
PubMed
Background: It is unclear whether patients of all races and ethnicities with gastroenteropancreatic (GEP) neuroendocrine neoplasm (NEN) have equivalent incidence and cancer-specific survival. Patients and Methods: Using the California Cancer Registry, all patients with GEP-NEN in California’s large and diverse population from 1992 to 2019 were identified. Age-adjusted incidence rates (AIRs) and cancer-specific mortality (CSM) risks were compared across racial and ethnic subgroups using structural equation modeling. Results: The non-Hispanic (NH) Black population had the highest rate of diagnosis every year (AIR2019, 7.4 per 100,000; 95% CI, 6.4–8.5). The AIRs across races and ethnicities and primary sites vary, and in 2019 statistically significantly increased for stomach, small intestine, pancreatic, and rectal NEN and for only the NH White population. Risk of mortality was neutral across many races and ethnicities for many primary sites. The only statistically significant disparity was a higher CSM rate for Hispanic patients compared with NH Black patients with small intestine NEN (subdistribution hazard ratio, 1.45; 95% CI, 1.10–1.91; P=.008). Findings suggest a higher CSM among NH Black and NH White patients with rectal NEN. Disparities in who presents with GEP-NEN were revealed across racial and ethnic populations and primary sites. The NH Black population incurred the highest rate overall consistently every year. This is the first study to evaluate cancer-specific survival disparities in all GEP-NEN primary sites across the Asian American/Native Hawaiian/Pacific Islander, Hispanic, NH Black, and NH White racial and ethnic populations. Many clinical and sociodemographic measures associated with risk of mortality differed across race and ethnicities. After careful control of those imbalances, there were few racial and ethnic disparities in risk of CSM. Conclusions: There is room to improve equity in the health care system and close the gap in diagnoses for the NH Black population with all GEP-NEN and in mortality for the Hispanic population with small intestine NEN.
Submitted November 27, 2023; final revision received August 20, 2024; accepted for publication October 14, 2024.
A. Paciorek and C. Mulvey are co–first authors.
Author contributions: Conceptualization: Bergsland. Data curation: Moon, Le, Shih, Whitman. Formal analysis: Paciorek, McKinley. Methodology: Paciorek, Mulvey, McKinley, Zhang, Cheng, Bergsland. Writing—original draft: Paciorek, Mulvey, Bergsland. Writing—review & editing: McKinley, Zhang, Cheng, Moon, Le, Shih, Whitman, Bergsland.
Disclosures: Dr. Mulvey has disclosed receiving grant/research support from RayzeBio. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute, Cancer Registry of Greater California. This work was supported in part by funding from National Cancer Institute (P30CA082103).
Disclaimer: The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the funders had any role in the conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7080. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
Supplementary Materials
- Supplemental Materials (PDF 2.60 MB)
© 2019-2024 National Comprehensive Cancer Network