Background: Disparities in cancer survival have been demonstrated between racial and ethnic groups. Several mechanisms could be involved, including differences in stage at presentation, treatment differences, and biological variation. Racial/ethnic disparities have not been comprehensively evaluated in adolescents and young adults (AYA) (age 15-29), a population at particular risk for disparities in socioeconomic status (SES) and delayed diagnosis. Methods: We utilized the Surveillance, Epidemiologic and End Results (SEER) 18 database to calculate hazard ratios (HR) of death within two years of diagnosis for Hispanic White (HW), Non-Hispanic Black (NHB), and Hispanic Black (HB) compared to Non-Hispanic White (NHW) individuals between the ages of 15 and 29 for each ICCC group. We then compared crude HR and HR adjusted for insurance status and/or stage at diagnosis to explore the influence of these factors. Results: HW, NHB and/or HB AYA were found to have significantly higher risk of death than NHW AYA for several cancer types. These associations were only partially attenuated after controlling for insurance status and stage at diagnosis (Table). Conclusions: Racial and ethnic disparities in survival exist among AYA in many cancer types. These differences are partially, but not fully, explained by insurance status and stage at presentation, suggesting influences of both biology and SES on the diagnostic and treatment processes. Further work should explore the mechanisms of these disparities.

Model adjusted for stage at presentation and insurance status.