Incidence of Stomach, Liver, and Colorectal Cancers by Geography and Social Vulnerability Among American Indian and Alaska Native Populations, 2010-2019.

Social determinants of health and associated systems, policies and practices are important drivers of health disparities. American Indian and Alaska Native (AI/AN) populations in the United States have elevated incidence rates of stomach, liver, and colorectal cancers compared to other racial groups. This study examined incidence rates of three gastrointestinal cancers among non-Hispanic AI/AN (NH-AI/AN) and non-Hispanic White (NHW) populations by geographic region and social vulnerability index (SVI) score. Incident cases diagnosed during 2010-2019 were identified from population-based cancer registries linked with the Indian Health Service patient registration databases. Age-adjusted incidence rates (per 100,000) for stomach, liver, and colorectal cancers were compared within NH-AI/AN and between NH-AI/AN and NHW populations by SVI score. Rates were higher among NH-AI/AN populations in moderate and high SVI score counties in Alaska, the Southern Plains, and the East compared with low SVI counties. Incidence rates among NH-AI/AN were elevated when compared to NHW populations by SVI category. Results indicated that higher social vulnerability may drive elevated cancer incidence among NH-AI/AN populations. Additionally, disparities between NH-AI/AN and NHW populations persist even when accounting for SVI. Exploring social vulnerability can aid in designing more effective interventions to address root causes of cancer disparities among AI/AN populations.

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Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2023.