Disaggregated lung cancer mortality trends in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients by key sociodemographic features including sex, age, and smoking status.

8593 Background: Lung cancer is a leading cause of death in AANHPI populations, yet studies aggregate patients with diverse cultural backgrounds and immigration histories into an “Asian American” monolith, obscuring high-risk subgroups. Prior national disaggregation work has not captured key demographic variables important to understanding epidemiologic trends. Methods: This study analyzed the US Multiple Cause of Death database for deaths from lung cancer from 2018–2023, sociodemographic information included age at death, sex, race/ethnicity, smoking status, and education. Disaggregated AANHPI subgroup trends were evaluated using ACS 1-year estimates; other analyses used CDC WONDER bridged-race populations. Joinpoint estimated annual percent change in mortality(APC)/AdjustedAPC by race and sex. Pearson's Chi-squared test tested comparisons. Results: From 2018-2023, there were 430,703 deaths due to lung cancer in males, of which 2.7% (n=11,441) were in AANHPI males; there were 379,199 deaths in females, of which 2.5% (n=9397) were in AANHPI females. There were demographic differences in deaths within AANHPI subgroups and compared against white patients. For example, 0.5% of deaths in white male and females occurred in those aged 25-44, but this younger age group had 2.1% (male) and 4.3% (female) of Indian American deaths and 1.2% (male) and 1.7% (female) of Chinese American deaths. Deaths in white patients were associated with smoking in 48% (male) and 43% (female) of cases, but in far less of Chinese American (17% male, 4.4% female) and Filipino American (21% male, 9.7% female) lung cancer deaths (p<0.001 comparison). From 2018–2023, adjusted AANHPI male lung cancer mortality significantly declined −1.63% (95% CI −1.87 to −1.38; p<0.0001) but this was not seen AANHPI females (AAPC −1.20%; −2.86 to 0.79; p=0.22). The magnitude of AANHPI mortality decreases were smaller than in White (male -3.95, -4.43 to -3.24, female -2.35, -3.64 to -1.10; p<0.0001 both) and Black (male -4.35, -5.22 to -3.52, female -2.99, -3.99 to -2.96) adults during the same time period (p<0.0001 both). Disaggregation showed rising lung cancer mortality in Filipino women (AAPC +1.99%; 95% CI 0.59–3.54; p=0.006) and upward trends in Vietnamese women (AAPC +2.29%; 95% CI −1.05 to 5.81), whereas most AANHPI men had stable or modestly declining mortality. Conclusions: Despite large gains in lung cancer mortality over time, AANHPI populations —especially AANHPI women— show slower improvements despite high never-smoker prevalence, underscoring the need for disaggregated research. Rising lung cancer mortality in specific unique populations like Filipino women should motivate further research and guide targeted community outreach so that all populations benefit from improvements in early diagnosis and precision oncology.