Sex and racial disparities in incidence and survival outcomes in adolescents and young adults (AYA) with lung cancer in the United States.

8033 Background: Limited data exists on the impact of race on the incidence and survival of lung cancer among adolescents and young adults (15 – 39 years). We examined the Surveillance, Epidemiology, and End Results Plus Data (SEER) to determine the association of race, sex and other demographic/clinicopathologic factors with incidence trends and survival in AYA. Methods: Lung cancer cases in AYA diagnosed between 2000 and 2020 were extracted from the SEER database. Age-standardized incidence rates per 100,000 persons were obtained, and the annual percentage change (APC) was used to compare incidence trends stratified by various demographics. Relative survival was calculated with the SEER Stat software. Multivariate regression analyses were performed to determine association with mortality. Results: We identified 5129 cases of lung cancer among AYA of which 50.9% (n=2610) were female, 56.6% (n=2904) were Non-Hispanic Whites (NHW), 17% (n=872) were Hispanics, 13.3% (n=684) were Non-Hispanic Blacks (NHBs), 12.5% (n=643) were Non-Hispanic Asian or Pacific Islander (NHAPI) and 0.5% (n=26) were Non-Hispanic American Indian/Alaska Native (NHAIA). Overall age-adjusted incidence rates (AAIR) of lung cancer among AYA decreased (APC, -2.01 - 2.72 to -1.34), slightly more in females (APC -2.05 -2.93 to -1.26) compared to males (APC, -2.01 -2.74 to -1.34). The greatest decrease was seen in NHWs -2.4 -3.1 to -1.8). There was no significant change in the AAIR among NHBs and Hispanics. NHBs showed the lowest 5-year survival rate (RSR-5: 58.8 57.3-60.1) with NHWs showing the highest survival (RSR-5: 77.8 77.4-78.3). On multivariable analysis, race was an independent predictor of mortality: Hispanics (HR: 0.78: 95% CI = 0.69 - 0.88) and NHAPI (HR: 0.79: 95% CI = 0.68 - 0.87) compared to NHW, had reduced odds of mortality. There was no association between sex and mortality. Conclusions: There is an overall decline in age-adjusted incidence rates of lung cancer, with more pronounced decline in females and specific racial groups. NHBs exhibited the lowest 5-year survival rate. Additionally, various socioeconomic and histologic factors demonstrated varying impacts on mortality. Table: see text