Effects of Socioeconomic Status in Colorectal Cancer Incidence and Clinical Outcome Differences Among Asian American Populations: A Systematic Review
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Introduction
Colorectal cancer (CRC) is the second leading cause of cancer death in the Asian American and Pacific Islander (API) population, a diverse and rapidly growing minority group in the US. Race, ethnicity, and socioeconomic status (SES) are known to impact outcomes of CRC, but the relationship is unclear in the context of the Asian American cohort and its diverse subgroups. This systemic review aims to gain insight into the relationship between the incidence and clinical outcomes of CRC in the Asian American community.
Methods
A systematic literature search was conducted per PRISMA protocol using PubMed, Scopus, EMBASE, Cochrane, CINAHL, and Web of Science databases, accessed on August 13, 2023.
Results
Of the 2225 studies identified, a total of 14 studies were included in the analysis. Four studies concluded that there was no association or variable response to SES measurements in CRC incidence in the Asian American population. However, there was evidence that the incidence of CRC varies among Asian American subgroups, using varying measures of SES. In the eight studies that measured mortality or survival as the primary outcome, seven found decreased mortality and increased survival in the API population despite changes in SES. Out of the six studies that measured incidence, four studies found no association with SES. A study found that Chinese Americans experienced a significant decrease in every socioeconomic status (SES) category. Japanese Americans experienced a significant decrease in the lowest SES category, while Koreans and Filipinos experienced a significant increase in both the lowest and highest SES categories. Therefore, grouping various Asian American ethnicities as a single monolithic “Asian” category is misleading.
Conclusion
Although the incidence of CRC was thought to be low and decreasing, this review found various trends in different Asian American subset groups. For example, there was a decrease in CRC rates in two ethnic groups and an increase in the other two ethnic groups. The potential causes of these varying CRC incidence rates are likely multifactorial and may include inadequate screening rates, lack of CRC education, and cultural barriers. Further studies are needed to understand these mechanisms. This review recommends a more detailed classification of the API ethnic population but not as a single monolithic entity as Asian. It also emphasizes preventative CRC screening within the API communities due to lower rates of CRC screening among them.
