Disparities in Next-Generation Genetic Sequencing Among Individuals with Cancer.

Abstract

We sought to investigate disparities in the utilization of next-generation genetic sequencing (NGS) across demographic groups related to several  common cancer subtypes. Data on patients aged 65 years or older with a diagnosis of gastrointestinal, lung, and breast cancer between 2015 and 2020 were obtained from the Medicare Standard Analytic Files. Propensity score matching was employed to reduce selection bias, and logistic regression analysis was performed to investigate racial, ethnic, and sex-based disparities in NGS utilization. Among 1,466,105 individuals, only 1.8% (n = 26,608) underwent NGS. Median patient age was 76 years (IQR 71-82), 36.8% (n = 539,201) of patients were male, and 87.8% (n = 1,287,805) were non-Hispanic White. Of note, minority patients, including non-Hispanic Black individuals (no NGS: 7.2% vs. NGS: 5.2%) and Hispanics (no NGS: 0.9% vs. NGS: 0.5%), as well as individuals residing in socially vulnerable neighborhoods (no NGS: 32.6% vs. NGS: 30.7%) were less likely to undergo NGS testing (all p < 0.001). On multivariable analysis, non-Hispanic Black race/ethnicity (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.69-0.78), Hispanic race/ethnicity (OR 0.64, 95% CI 0.53-0.77), and males (OR 0.97, 95% CI 0.94-0.99) remained at lower odds of undergoing NGS. Non-Hispanic Black and Hispanic patients, along with socioeconomically vulnerable individuals, were less likely to undergo NGS. Addressing these inequities is crucial to ensure that all patients have equal opportunities to receive effective, personalized cancer care that is equitable across diverse populations.