Writing Support Group for Medical School Faculty-A Simple Way to Do It.

Problem: Writing for publication is a core activity for many medical school faculty, but faculty report numerous challenges to publication. To help address these challenges, some medical schools establish writing support programs, but those programs are often resource-intensive, involving didactic courses, accountability groups, formal mentorships, and even assistance from professional writers. Not all medical schools, however, provide resources for such programs, and many faculty members, especially clinicians, lack time needed to participate. Furthermore, success of these programs is typically judged by the total number of papers published. However, many clinicians would judge success as publication of the occasional papers they decide to write, not the total number of papers they or the group publish. With these issues in mind, we established a low-resource writing program focused on individual acceptance rates rather than total publications. Intervention: Our writing program is an informal group that meets monthly. Members bring their ideas for papers and drafts of papers, and other members provide critique and suggestions for improvement. Members then revise their papers to address that critique prior to journal submission. There are no formal or assigned mentors, courses, lectures, or writing assistants. Context: The program takes place in our family medicine department, in which faculty have various roles. Some group members are clinician-educators seeking to publish occasional clinical reviews or research articles; others are PhDs seeking to publish on aspects of their work. Impact: During the six years of the program, 86% of papers reviewed by the group were accepted for publication and 94% of those were accepted by the journal to which they were first submitted. Publication success rate of individual members averaged 79%. This exceeds the 30-40% acceptance rate for scholarly journals worldwide. Group members published an average of 5.2 papers per member, with some publishing as few as 2-3 papers and others as many as 10-11. Lessons Learned: An informal, low-resource writing program in medical school departments can help faculty reach their publication goals. We found that members were satisfied by having the group help them publish whatever number of papers they decided to write. The program's simple, informal approach fostered a culture of respectful and collegial interactions, in which members learned to depend on and accept critiques from colleagues. Finally, an unexpected benefit of our program resulted from membership of both clinicians and non-clinicians. This provided feedback from individuals with different perspectives, which enhanced development of manuscripts.

Disparities in Text Messaging Interventions to Improve Diabetes Management in the United States.

Substantial progress has been made in the development of evidence-based interventions to facilitate the management of type 2 diabetes. The increase in ownership of mobile phones has made short messaging services (SMS, or text messaging) a feasible way to enhance information delivery. The goals of this study were to 1) summarize characteristics of diabetes SMS interventions implemented in the United States and 2) identify the extent to which disadvantaged populations are represented in SMS-based diabetes management intervention studies. We conducted a literature search to identify published studies of type 2 diabetes self-management SMS interventions conducted with adults in the United States. Of the 792 articles retrieved, only 9 met inclusion criteria. We systematically extracted data on the theoretical basis, recruitment, incentives, inclusion/exclusion criteria, strategies toward ensuring a racially/ethnically or income-diverse sample, text message delivery, and study duration. Sixty-three percent of the participants across the nine studies were non-white. Only two studies reported participants' education level, and four captured non-English-speaking status. Interventions varied in offering one-way, two-way, or a combination of messaging strategies. Five studies did not describe cultural adaptations or report results separately for different cultural groups. None of the studies provided cell phones, and not having texting capability was an exclusion criterion for six studies. There is a dearth of published research on type 2 diabetes management interventions using text messaging among racially/ethnically or income-diverse populations. Future interventions should be better tailored to these target populations and include the collection of complete sociodemographic data and cell phone/smartphone availability, thereby ensuring cultural appropriateness.

Alaska Native genomic research: perspectives from Alaska Native leaders, federal staff, and biomedical researchers.

Meaningful engagement of Alaska Native (AN) tribes and tribal health organizations is essential in the conduct of socially responsible and ethical research. As genomics becomes increasingly important to advancements in medicine, there is a risk that populations not meaningfully included in genomic research will not benefit from the outcomes of that research. AN people have historically been underrepresented in biomedical research; AN underrepresentation in genomics research is compounded by mistrust based on past abuses, concerns about privacy and data ownership, and cultural considerations specific to this type of research. Working together, the National Human Genome Research Institute and two Alaska Native health organizations, Southcentral Foundation and the Alaska Native Health Board, cosponsored a workshop in July 2018 to engage key stakeholders in discussion, strengthen relationships, and facilitate partnership and consideration of participation of AN people in community-driven biomedical and genomic research. AN priorities related to translation of genomics research to health and health care, return of genomic results, design of research studies, and data sharing were discussed. This report summarizes the perspectives that emerged from the dialogue and offers considerations for effective and socially responsible genomic research partnerships with AN communities.

Addressing Hepatitis C within a Southwest Tribal Community.

Objective: The objective was to identify and treat segments of the local population at greatest risk for viral hepatitis C (HCV) infections. Design: The tribal-based HCV initiatives included community involvement and outreach and HCV data were mined and analyzed. Medical records were reviewed, and new HCV tribal health policies and procedures were developed. Results: A total of 251 tribal members (63.7% male) were diagnosed with HCV and had a positive confirmatory test between the years 2009 and 2014. Through community-based outreach efforts, 85 HCV patients were successfully contacted for education, field-testing, referral and follow-up, an increase of more than 300%. Conclusions: The tribe increased ways to monitor HCV risk factors and communicable disease pathways.

Indigenous mortality (revealed): the invisible illuminated.

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics.

American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009.

OBJECTIVES: We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. METHODS: We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. RESULTS: The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. CONCLUSIONS: Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable.

Types of Racism and Health Disparities and Inequalities among Cancer Patients: An Editorial Reflection of Articles in This Special Issue of IJERPH.

Racism has been a long-standing influential factor that has negatively impacted both past and current health disparities within the United Sates population. Existing problems of racism and its impact on both health disparities and health inequalities were only amplified during the COVID-19 pandemic. The pandemic allowed both clinicians and researchers to recognize a growing list of health concerns at the macro-, meso-, and micro-level among underserved racially minoritized patients with specific chronic illnesses such as cancer. Based on these concerns, this Special Issue was designed to highlight the challenges of cancer screening, cancer treatment, and cancer-centered educational outreach among racially minoritized communities.

Advancing Cancer Workforce Capacity for American Indians and Alaska Natives: The Development of a Validated System to Optimize Trainee Participation and Outcome Tracking.

Although American Indian and Alaska Native (AIAN) students are the most underrepresented group in the U.S. in biomedical and health sciences relative to population size, little is known about long-term research education programs and outcome tracking. For over 20 years, the Partnership for Native American Cancer Prevention (NACP) has been supported under the National Cancer Institute's (NCI)-funded Comprehensive Partnerships to Advance Cancer Health Equity (CPACHE) program. Programming included hands-on mentored research and an array of development opportunities. A validated tracking system combining participation records, institutional records, and enrollment/degree attainment from the National Student Clearinghouse documents outcomes. Collectively (2002-2022) NACP engaged 367 AIAN trainees, of whom 237 individuals earned 220 bachelors, 87 masters, and 34 doctoral/professional degrees. Approximately 45% of AIAN doctoral recipients are currently engaged in academic or clinical work, and 10% in industry or tribal leadership. A total of 238 AIAN students participated in mentored research, with 85% demonstrating strong outcomes; 51% attained a degree, and 34% are currently enrolled. Implementation of a robust tracking system documented acceleration in degree attainment over time. Next steps will evaluate the most impactful training activities on student outcomes.

Differential effects of obesity on perioperative outcomes in renal cell carcinoma patients based on race and ethnicity and neighborhood-level socioeconomic status.

Background: Obesity is a well-established risk factor of renal cell carcinoma (RCC), however the impact of obesity on surgical outcomes for racial and ethnic minority patients with RCC is unclear. This study investigated whether a higher body mass index (BMI) or obesity (BMI ≥30 kg/m2) was associated with worse perioperative outcomes and if there were heterogeneous effects based on race, ethnicity, and neighborhood-level socioeconomic factor. Methods: In this single-center cross-sectional study, medical records of patients who underwent partial or radical nephrectomy between 2010 and 2022 were retrospectively reviewed. Logistic regression analysis was performed to assess associations of BMI and perioperative outcomes [ischemia time, estimated blood loss (EBL), and length of hospital stay]. Results: A total of 432 patients, including 49.8% non-Hispanic White (NHW), 35.0% Hispanic, and 6.9% American Indian (AI) patients, were included. Median [interquartile range (IQR)] BMI was 30.2 (26.3-35.2) kg/m2, and Hispanic (31.5) and AI (32.5) patients had higher median BMI than NHW (29.1) patients (P=0.006). Median ischemia time, EBL, and length of hospital stay were 18.5 (IQR, 15.0-22.4) minutes, 150 (IQR, 75.0-300.0) mL, and 3 (IQR, 2-5) days. BMI ≥35 kg/m2 was associated with a longer ischemia time [>18.5 minutes; odds ratio (OR), 5.17; 95% confidence interval (CI): 1.81-14.76; P=0.002], and the association was stronger in NHW than Hispanic patients (BMI continuous OR, 1.13; 95% CI: 1.04-1.22; P=0.004 in NHW and OR, 1.07; 95% CI: 0.98-1.17; P=0.12 in Hispanics). Class I and II/III obese patients had over two-fold increased odds of a larger EBL (>150 mL) than patients with normal weight (OR, 2.17; 95% CI: 1.03-4.59; P=0.04 for class I and OR, 2.24; 95% CI: 1.04-4.84; P=0.04 for class II/III obese patients). This association was stronger in patients from neighborhoods with high social deprivation index (SDI) and in NHW patients (BMI ≥30 vs. <30 kg/m2, OR, 3.53; 95% CI: 1.57-7.97; P=0.002 in high SDI neighborhoods and OR, 2.38; 95% CI: 1.10-5.14; P=0.03 in NHW). BMI was not associated with a longer hospital stay. Conclusions: In this study, obesity increased likelihood of worse perioperative outcomes, and the associations varied based on race and ethnicity and neighborhood-level socioeconomic factors.

Neighborhood social vulnerability and disparities in time to kidney cancer surgical treatment and survival in Arizona.

BACKGROUND: Hispanics and American Indians (AI) have high kidney cancer incidence and mortality rates in Arizona. This study assessed: (1) whether racial and ethnic minority patients and patients from neighborhoods with high social vulnerability index (SVI) experience a longer time to surgery after clinical diagnosis, and (2) whether time to surgery, race and ethnicity, and SVI are associated with upstaging to pT3/pT4, disease-free survival (DFS), and overall survival (OS). METHODS: Arizona Cancer Registry (2009-2018) kidney and renal pelvis cases (n = 4592) were analyzed using logistic regression models to assess longer time to surgery and upstaging. Cox-regression hazard models were used to test DFS and OS. RESULTS: Hispanic and AI patients with T1 tumors had a longer time to surgery than non-Hispanic White patients (median time of 56, 55, and 45 days, respectively). Living in neighborhoods with high (≥75) overall SVI increased odds of a longer time to surgery for cT1a (OR 1.54, 95% CI: 1.02-2.31) and cT2 (OR 2.32, 95% CI: 1.13-4.73). Race and ethnicity were not associated with time to surgery. Among cT1a patients, a longer time to surgery increased odds of upstaging to pT3/pT4 (OR 1.95, 95% CI: 0.99-3.84). A longer time to surgery was associated with PFS (HR 1.52, 95% CI: 1.17-1.99) and OS (HR 1.63, 95% CI: 1.26-2.11). Among patients with cT2 tumor, living in high SVI neighborhoods was associated with worse OS (HR 1.66, 95% CI: 1.07-2.57). CONCLUSIONS: High social vulnerability was associated with increased time to surgery and poor survival after surgery.

Sleep Time, Physical Activity, and Screen Time among Montana American Indian Youth.

The purpose of this study is to describe sleep, PA, and screen time behaviors among rural American Indian (AI) youth, stratified by sex and grade, to better understand how to address these health behaviors in AI youth. Body composition, a screen time survey, and demographic information were collected from 65 AI youth. Accelerometers were worn for 7 days. Sixty percent were overweight or obese. Sleep did not differ by sex or grade, with an actigraphy-based total sleep time (aTST) of 7.8 h per night. Boys had significantly more light PA (p = 0.002) and vigorous PA (p = 0.01) compared to girls. Screen time did differ by sex but not by grade, with girls in the sixth and seventh grades reporting more screen time than boys, but boys in the eighth grade reporting more screen time than girls. Despite sex differences in screen time, high levels of screen time and obesity and low levels of PA and sleep are a concern in this population.

Mammography Compliance for Arizona and New Mexico Hispanic and American Indian Women 2016-2018.

Hispanic and American Indian (AI) women experience lower breast cancer incidence than non-Hispanic White (NHW) women, but later-stage diagnoses and lower survival rates, suggesting issues with screening and healthcare access. Between 1999-2015, NHW breast cancer incidence decreased by 10% but increased by 8% for AI women. This study used 2016 and 2018 Behavioral Risk Factor Surveillance System data for Arizona and New Mexico to explore mammography screening. Analyses included Hispanic, AI, and NHW women aged ≥40 years (n = 12,830) to calculate age-specific compliance by race/ethnicity, logistic regression, and adjusted and sample-weighted evaluated associations between compliance and socio-economic covariates. In total, 75.1% of Hispanic women aged 50-74 reported mammography in the past two years (United States Preventive Services Task Force compliant) compared to 73.9% of NHW and 71.0% of AI women. Women who reported doctor visits in the past 12 months were likelier to comply than those without (AOR = 4.2 for Hispanic, 2.9 for AI, and 3.2 for NHW women). Reporting access to a personal doctor was related to compliance, except for AI women. While screening compliance was over 74%, visiting a healthcare provider in the past 12 months was essential. AI women reported issues that suggest unique challenges when deciding on mammography.

A Qualitative Study on Parenting Practices to Sustain Adolescent Health Behaviors in American Indian Families.

American Indian (AI) adolescents who practice healthy behaviors of sleep, nutrition, physical activity, and limited screen time can lower their lifetime risk of diet-sensitive disease. Little is known about how AI parenting practices influence the health behaviors of youth. The objective of this qualitative study was to explore how a group of AI parents of youths at risk of disease influenced their youth's health behaviors after a family intervention. A secondary objective was to understand the role of AI parents in supporting and sustaining health behavior change in their youths following the intervention. Semi-structured in-depth interviews were conducted with AI parents (n = 11) and their young adolescents, 10-15 years old (n = 6). Parents reported facilitators to how they enacted healthy lifestyle behaviors, including family togetherness, routines, youth inclusion in cooking, and motivation due to a health condition in the family. Barriers to enacting healthy behaviors included a lack of time, a lack of access to health resources, negative role modeling, and the pervasiveness of screen media. Three major themes about the role of AI parenting emerged inductively from the interview data: "Parenting in nontraditional families", "Living in the American grab-and-go culture", and "Being there and teaching responsibility". The importance of culture in raising youths was emphasized. These findings inform strategies to promote long-term adherence to behavior changes within the intervention. This study contributes to public health conversations regarding approaches for AI youths and families, who are not well represented in previous health behavior research.

Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences.

The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer continuum. Social conditions are instrumental in better understanding the contemporary and historical constructs that create these patterns of disparities. There is an equally important body of evidence that points to the ways that social conditions shape biological pathways. To date, these areas of research are, for the most part, separate. This paper calls for a bridging of these two areas of research to create new directions for the field of cancer disparities. We discuss inflammation, epigenetic changes, co-morbidities, and early onset as examples of the biological consequences of social conditions that BIPOC populations experience throughout their lifespan that may contribute to disproportionate tumorigenesis and tumor progression.

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients.

Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84-1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona.

American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients' demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07-2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08-2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21-2.76 and HR 1.59 95% CI: 1.30-1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.

Renal Cell Carcinoma Health Disparities in Stage and Mortality among American Indians/Alaska Natives and Hispanic Americans: Comparison of National Cancer Database and Arizona Cancer Registry Data.

Renal cell carcinoma (RCC) is one of the top 10 cancers in the United States. This study assessed RCC health disparities in American Indians/Alaska Natives (AIs/ANs) and Hispanic Americans (HAs) focusing on advanced-stage and mortality. RCC patients' data were obtained from the National Cancer Database (NCDB) and Arizona Cancer Registry (ACR). Logistic and Cox regression analyses were performed to ascertain the effect of race/ethnicity on stage and mortality, adjusting for neighborhood socioeconomic factors, rural/urban residence pattern, and other factors. In both data sets, AIs/ANs had significantly increased odds of advanced-stage RCC in the unadjusted model, but not in adjusted models. Mexican Americans had higher odds of advanced-stage compared to non-Hispanic Whites in NCDB (OR 1.22, 95% CI: 1.11-1.35) and ACR (OR 2.02, 95% CI: 1.58-2.58), even after adjusting for neighborhood characteristics. AIs/ANs did not show increased mortality risk in NCDB after adjusting for neighborhood characteristics, while the association remained significant in ACR (HR 1.33, 95% CI: 1.03-1.72). The great risk of all-cause and RCC-specific mortality was observed in U.S.-born Mexican Americans in Arizona (HR 3.21, 95% CI: 2.61-3.98 and sub-distribution HR 2.79, 95% CI: 2.05-3.81). RCC disparities in AIs/ANs is partially explained by neighborhood factors, but not in HAs.

Designing Inclusive HPV Cancer Vaccines and Increasing Uptake among Native Americans-A Cultural Perspective Review.

Despite a global and nationwide decrease, Native Americans continue to experience high rates of cancer morbidity and mortality. Vaccination is one approach to decrease cancer incidence such as the case of cervical cancer. However, the availability of vaccines does not guarantee uptake, as evident in the Coronavirus 2019 pandemic. Therefore, as we consider current and future cancer vaccines, there are certain considerations to be mindful of to increase uptake among Native Americans such as the incidence of disease, social determinants of health, vaccine hesitancy, and historical exclusion in clinical trials. This paper primarily focuses on human papillomavirus (HPV) and potential vaccines for Native Americans. However, we also aim to inform researchers on factors that influence Native American choices surrounding vaccination and interventions including cancer therapies. We begin by providing an overview of the historical distrust and trauma Native Americans experience, both past and present. In addition, we offer guidance and considerations when engaging with sovereign Tribal Nations in vaccine development and clinical trials in order to increase trust and encourage vaccine uptake.

NACP: Partnership for Native American Cancer Prevention.

Cancer trends over a two-decade period show a greater reduction in cancer mortality rates for non-Hispanic Whites than for Native Americans. The Partnership for Native American Cancer Prevention (NACP) was established to address cancer health disparities that impact Native Americans. The partners are Northern Arizona University, the University of Arizona Cancer Center, Arizona's tribal communities and the National Cancer Institute. The activities include outreach, research and cancer education. Overall, NACP seeks to expand capacity for culturally-sensitive and community-relevant research on cancer, and to continue developing respectful collaborations that will empower sovereign Native American communities to define, implement, and achieve their goals for cancer health equity.

Racial and Ethnic Disparities in Preoperative Surgical Wait Time and Renal Cell Carcinoma Tumor Characteristics.

Racial/ethnic minority groups have a disproportionate burden of kidney cancer. The objective of this study was to assess if race/ethnicity was associated with a longer surgical wait time (SWT) and upstaging in the pre-COVID-19 pandemic time with a special focus on Hispanic Americans (HAs) and American Indian/Alaska Natives (AIs/ANs). Medical records of renal cell carcinoma (RCC) patients who underwent nephrectomy between 2010 and 2020 were retrospectively reviewed (n = 489). Patients with a prior cancer diagnosis were excluded. SWT was defined as the date of diagnostic imaging examination to date of nephrectomy. Out of a total of 363 patients included, 34.2% were HAs and 8.3% were AIs/ANs. While 49.2% of HA patients experienced a longer SWT (≥90 days), 36.1% of Non-Hispanic White (NHW) patients experienced a longer SWT. Longer SWT had no statistically significant impact on tumor characteristics. Patients with public insurance coverage had increased odds of longer SWT (OR 2.89, 95% CI: 1.53-5.45). Public insurance coverage represented 66.1% HA and 70.0% AIs/ANs compared to 56.7% in NHWs. Compared to NHWs, HAs had higher odds for longer SWT in patients with early-stage RCC (OR, 2.38; 95% CI: 1.25-4.53). HAs (OR 2.24, 95% CI: 1.07-4.66) and AIs/ANs (OR 3.79, 95% CI: 1.32-10.88) had greater odds of upstaging compared to NHWs. While a delay in surgical care for early-stage RCC is safe in a general population, it may negatively impact high-risk populations, such as HAs who have a prolonged SWT or choose active surveillance.