Cancer mortality higher among American Indian and Alaska Native individuals
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Overall cancer mortality among American Indian/Alaska Native individuals appeared higher than among white individuals despite similar cancer incidence, according to findings published in CA: A Cancer Journal for Clinicians.
The disparity is driven by common cancers — such as breast and prostate cancer — that are receptive to early detection, researchers wrote.
“The mortality disparities were very striking. Not only has cancer mortality among AI/AN individuals been rarely reported, after correction for racial misclassification on death certificates it is significantly higher than white individuals,” Tyler B. Kratzer, MPH, associate scientist II of cancer surveillance research at the American Cancer Society and lead author of the study, told Healio. “Given similar incidence, it is clear there are health care disparities impacting receipt of cancer care, from screening to treatment.”
Background
An estimated 9.7 million people identified as American Indian/Alaska Native (AI/AN) in 2020, representing approximately 3% of the U.S. population, according to study background.
This group — a diverse population that lives in 574 federally recognized tribes and more than 200 unrecognized ones — often faces challenges related to economic opportunity, healthy food options and health care access.
Certain statistics point toward negative health outcomes for members of the AI/AN population. For example, they are twice as likely to live in poverty as white individuals, regardless of where they live.
Additionally, health care funding for the population does not meet its needs.
Approximately 2.6 million AI/AN individuals receive health care access at Indian Health Service or tribal health care facilities, researchers reported. Only $6.23 billion — or 13% of the $48 billion for full funding — was allocated in 2021 for the Indian Health Service. Full coverage of cancer screenings or prevention services are not guaranteed to Indian Health Service or tribal facility beneficiaries.
Methodology
Kratzer and colleagues aimed to examine cancer incidence and mortality among AI/AN individuals compared with white individuals.
To do so, they used NCI, CDC and North America Association of Central Cancer Registries population-based data from the District of Columbia and 49 states that met quality criteria — excluding only Nevada — from 2014 to 2018.
Results
Overall, AI/AN individuals had a 2% higher cancer incidence rate but an 18% higher cancer mortality rate than white individuals.
Disparities varied widely by cancer type and geographic region.
For example, researchers reported a 15% lower incidence of breast cancer among AI/AN but 8% higher breast cancer mortality. Results showed 12% lower incidence of prostate cancer among AI/AN individuals but 31% higher prostate cancer mortality.
In addition, researchers reported approximately 40% higher colorectal cancer incidence and mortality rates among AI/AN individuals than white individuals.
The disparity is exacerbated by steeper increases in early-onset colorectal cancer.
An analysis of two times periods — 1998 to 2002, and 2014 to 2018 — showed colorectal cancer incidence rates among individuals aged 20 to 49 years increased by 85% among Alaska Native individuals compared with 33% among white individuals.
Mortality rates for kidney cancer and infection-related cancers — such as cervical, stomach or liver cancers — appeared twice as high among AI/AN individuals.
“Explanations for these disparities include two major factors,” Kratzer told Healio. “[One] is long-standing inequities in socioeconomic status, education and access to care as a result of historical and contemporary racism. [The other is] consistent underfunding of the Indian Health Service and other programs, which disproportionately impacts AI/AN individuals residing in rural areas with low socioeconomic status, exacerbating inequities.”
Next steps
The findings highlight the need for better strategies to expand access to cancer screening, increase access to high-quality treatment and reduce the prevalence of chronic oncogenic infections among AI/AN individuals, researchers concluded.
“Our report shows that the American Indian and Alaska Native community is disproportionately impacted by cancers that are either preventable or detectable early, when treatment saves lives,” Kratzer said in an American Cancer Society-issued press release. “Mitigating the disparate burden will require expanding financial support of tribal health care, as well as increased collaboration and engagement with the marginalized population.”
References:
- Kratzer TB, et al. CA Cancer J Clin. 2022;doi:10.3322/caac.21757.
- New study shows cancer mortality higher among American Indian and Alaska Native individuals; colorectal cancer rapidly increasing before age 50 (press release). Available at: pressroom.cancer.org/AIANStudy. Published Nov. 8, 2022. Accessed Nov. 15, 2022.
For more information:
Tyler B. Kratzer, MPH, can be reached at Surveillance Research, American Cancer Society, 3380 Chastain Meadows Parkway NW, Suite 200, Kennesaw, GA 30144; email: tyler.kratzer@cancer.org.
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Kratzer TB, et al. CA Cancer J Clin. 2022;doi:10.3322/caac.21757.
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