QS26. Disaggregated analysis of cervical cancer outcomes among Hispanic subgroups in the United States

Introduction:
Hispanic individuals are the largest U.S. ethnic minority, yet aggregation of this diverse population masks subgroup differences in cervical cancer presentation and survival. This study evaluated disparities in outcomes among distinct Hispanic subgroups.



Methods:
We conducted a retrospective analysis of the National Cancer Database (2009–2020). Patients with stage I–IV cervical cancer were included; those with incomplete race or stage data were excluded. Cases staged under FIGO 2009 were converted to FIGO 2018. Multivariable logistic regression assessed the odds of advanced-stage disease, while Cox proportional hazards models estimated three-year overall survival, adjusting for demographic, socioeconomic, and clinical covariates, including interactions between ethnicity, insurance, and income to examine access-related effects.



Results:  
Among 45,751 patients, 2,554 were Hispanic: Mexican (n=1,383), South/Central American (n=655), Puerto Rican (n=290), Cuban (n=114), and Dominican (n=112), compared with 37,704 Non-Hispanic White (NHW) patients. Pooled Hispanic patients had similar odds of advanced-stage disease (OR 1.03; p< 0.05) relative to NHWs. When evaluated by subgroup, Puerto Rican patients had higher odds of advanced disease (OR 1.31; p< 0.05), while other subgroups showed no significant differences. At three years, pooled Hispanic patients had improved survival compared with NHWs (HR 0.69; p< 0.001). Subgroup analysis showed the greatest survival among South/Central American (HR 0.53; p< 0.001) and Dominican (HR 0.48; p< 0.001) patients, with moderate improvement among Mexicans (HR 0.67; p< 0.001). Socioeconomic and treatment patterns varied across subgroups. South/Central Americans had the highest uninsured rates (27.0%) and Dominicans were most reliant on public insurance (66.7%). South/Central Americans were most represented in the highest income quartile (37.1%), while Dominicans (42.9%) and Puerto Ricans (33.4%) were concentrated in the lowest. Initiation of chemotherapy within 30 days of diagnosis was lowest for Dominicans (14.7%) and Mexicans (14.7%) compared to NHWs (25.9%).


Conclusions:
Disaggregating Hispanic subgroups uncovered distinct survival patterns and diagnostic disparities that are obscured in aggregate analyses. These findings emphasize the need for culturally informed outreach, equitable access to guideline-concordant care, and survivorship programs tailored to subgroup-specific needs. Incorporating disaggregated data into outcomes research is critical to advancing equity and improving cervical cancer care.