Colorectal cancer among Asians and Pacific Islanders in the U.S.: Survival disadvantage for the foreign-born

Background: Asian Americans and Pacific Islanders (AAPI) have better colorectal cancer survival than other racial populations. However, immigrants face challenges that may place them at higher risk for late diagnosis and death. Methods: To compare survival between the foreign- and U.S.-born, we identified 17,302 AAPI colorectal cancer patients between 1973 and 1998 from the Surveillance, Epidemiology, and End-Results (SEER) Program. Patients were categorized as foreign-born or U.S.-born using multiple imputation methods. Results: Foreign birth was associated with higher risk for death from any cause (hazard ratio [HR] 1.29; 95% CI 1.23-1.36) and with modestly higher risk after adjustment for selected demographic characteristics (HR 1.13; 95% CI 1.05-1.21) and registry site (HR 1.05; 95% CI 0.98-1.14). Although foreign-born AAPI were more likely to present later, additional adjustment for cancer stage reduced but did not eliminate their higher risk of death (HR 1.09; 95% CI 1.01-1.18) Conclusions: Compared to the U.S.-born, foreign-born AAPI have poorer survival following colorectal cancer diagnosis. Future investigation of the care processes after diagnosis may be important in understanding these differences.