Journal article
Impact of Comorbidities on Survival among American Indian and Alaska Native People with Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Medicare Study
Cancer epidemiology, biomarkers & prevention, Vol.35(8), pp.1317-1328
08/01/2026
DOI: 10.1158/1055-9965.EPI-26-0182
PMID: 42227960
Abstract
American Indian and Alaska Native (AIAN) people experience lower cancer survival than other racial/ethnic groups for several cancer sites. We explored predictors of cancer survival among AIAN people, with a specific focus on the potential impact of comorbidities.
We analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. AIAN people diagnosed with breast (female only), lung, and colorectal cancers from 2000-2019, aged 66+ years at diagnosis, and with at least one year of Medicare coverage prior to diagnosis were included in the study. We used multivariable-adjusted Cox proportional hazards models to assess associations of comorbidity class, previously defined using latent class analysis, with overall and cancer-specific survival, adjusted for sociodemographic characteristics and area-based social measures.
The sample included 831 individuals with female breast cancer, 1009 individuals with colorectal cancer, and 1195 individuals with lung cancer. Comorbidity class was associated with five-year hazard of death from any cause for breast and colorectal cancer, but not lung cancer patients. Further, we only observed associations of comorbidity class with five-year cancer-specific death for lung cancer, where the class associated with heart and vascular-related conditions experienced increased hazard of death.
Higher comorbidity prevalence among AIAN people compared to other racial/ethnic groups did not contribute to observed disparities in cancer-specific survival; however, AIAN people with comorbid conditions may be more likely to experience death from any cause than those without these conditions.
Differences in prevalence of comorbid conditions are unlikely to drive disparities in cancer-specific survival observed among AIAN peoples.
Details
- Title: Subtitle
- Impact of Comorbidities on Survival among American Indian and Alaska Native People with Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Medicare Study
- Creators
- Sarah H Nash - University of New MexicoBradley T Loeffler - University of IowaJennifer Erdrich - University of ArizonaElizabeth Verhage - University of IowaJamie Sorensen - University of IowaVanessa E Slater - University of IowaFaith Elenwa - University of IowaJerreed D Ivanich - University of Colorado Anschutz Medical CampusBrian J Smith - University of IowaKeely K Ulmer - University of IowaBradley D McDowell - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Cancer epidemiology, biomarkers & prevention, Vol.35(8), pp.1317-1328
- DOI
- 10.1158/1055-9965.EPI-26-0182
- PMID
- 42227960
- NLM abbreviation
- Cancer Epidemiol Biomarkers Prev
- ISSN
- 1538-7755
- eISSN
- 1538-7755
- Publisher
- American Association for Cancer Research
- Grant note
- National Cancer Institute (NCI): P30CA086862 National Institutes of Health (NIH): R21MD018641
We would like to recognize the AIAN cancer survivors whose stories we tell through analysis of the data herein and publication of this manuscript. We would also like to acknowledge the wisdom and knowledge of our Community Advisory Board, whose input has improved this research and the current manuscript. The collection of cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code section 103885; Centers for Disease Control and Prevention National Program of Cancer Registries, under cooperative agreement 1NU58DP007156; the NCI's SEER Program under contract HHSN261201800032I awarded to the University of California, San Francisco, contract HHSN261201800015I awarded to the University of Southern California, and contract HHSN261201800009I awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and do not necessarily reflect the opinions of the State of California, Department of Public Health, the NCI, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors. S.H. Nash, B.T. Loeffler, E. Verhage, B.J. Smith, K.K. Ulmer, and B.D. McDowell were supported by the University of Iowa Holden Comprehensive Cancer Center (P30CA086862, PI: M. Burkhard). S.H. Nash, E. Verhage, J. Sorensen, K.K. Ulmer, and B.D. McDowell were supported by the NIH (R21MD018641 PI: S.H. Nash). S.H. Nash is also supported by the University of New Mexico Comprehensive Cancer Center (P30CA118100 PI: Y. Sanchez). J. Erdrich is supported by K08CA276137 (PI: J. Erdrich).
- Language
- English
- Electronic publication date
- 06/02/2026
- Date published
- 08/01/2026
- Academic Unit
- Epidemiology; Biostatistics; Community and Behavioral Health; Holden Comprehensive Cancer Center
- Record Identifier
- 9985167574202771
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