Kidney Cancer Incidence among Non-Hispanic American Indian and Alaska Native Populations in the United States, 1999 to 2020

Abstract

Background: Non-Hispanic American Indian and Alaska Native (NH-AI/AN) people exhibit a disproportionate incidence of kidney cancer. Nationally aggregated data do not allow for a comprehensive description of regional disparities in kidney cancer incidence among NH-AI/AN communities. This study examined kidney cancer incidence rates and trends among NH-AI/AN compared with non-Hispanic White (NHW) populations by geographic region.

Methods: Using the United States Cancer Statistics American Indian and Alaska Native (AI/AN) Incidence Analytic Database, age-adjusted incidence rates (per 100,000) of kidney cancers for NH-AI/AN and NHW people for the years 2011 to 2020 combined using surveillance, epidemiology, and end Results (SEER)∗stat software. Analyses were restricted to non-Hispanic individuals living in purchased/referred care delivery area (PRCDA) counties. Average annual percent changes (AAPCs) and trends (1999-2019) were estimated using Joinpoint regression analyses.

Results: Rates of kidney cancer incidence were higher among NH-AI/AN compared with NHW persons in the United States overall and in five of six regions. Kidney cancer incidence rates also varied by region, sex, age, and stage of diagnosis. Between 1999 and 2019, trends in kidney cancer rates significantly increased among NH-AI/AN males (AAPC = 2.7%) and females (AAPC = 2.4%). The largest increases were observed for NH-AI/AN males and females aged less than 50 years and those diagnosed with localized-stage disease.

Conclusions: Study findings highlight growing disparities in kidney cancer incidence rates between NH-AI/AN and NHW populations.

Impact: Differences in geographic region, sex, and stage highlight the opportunities to decrease the prevalence of kidney cancer risk factors and improve access to preventive care.

Figure 1:

Trends in Kidney Cancer Incidence among non-Hispanic American Indian/Alaska Native^a and non-Hispanic White Males and Females All Regions, PRCDA, US 1999–2019 Figure 1 shows an image of a graph with four lines that represent the trends and average annual percent change in incidence race associated with kidney cancer incidence between the years 1999–2019 for NH-AI/AN males and females and NHW males and females Average annual percent change (AAPC)^b 1999–2019 NHW Male : 1.7* (95% CI: 1.4–2.1) NH-AI/AN Male 2.7* (95% CI: 1.9–3.4) NHW Female: 1.7* (95% CI: 1.3–2.0) NH-AI/AN Female: 2.4* (95% CI:1.6–3.2) Source: Cancer Registries in the National Program of Cancer Registries (NPCR) of the Centers for Disease Control and Prevention and the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute Note: The COVID-19 pandemic disrupted health services, leading to delays and reductions in cancer screening, diagnosis, and reporting to some central cancer registries. This may have contributed to an observed decline in 2020 incidence for most cancer sites. The 2020 incidence datapoint was not included in the trend analysis in order to avoid incorrect interpretations of the effect of cancer prevention and early detection efforts. PRCDA indicates Purchased/Referred Care Delivery Areas; IHS: Indian Health Service; NH-AI/AN: non-Hispanic American Indian/Alaska Natives; NHW: non-Hispanic white * 2-sided P<0.05 ^a AI/AN race is reported by NPCR and SEER registries or through linkage with the IHS patient registration database. Includes only AI/AN of non-Hispanic origin. Hispanic origin data for ND and WI were suppressed. ^b APC (Annual Percent Change) is based on rates that were age-adjusted to the 2000 US standard population (11 age groups, Census P25–1130).