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Shariff-Marco S, Gomez SL, Canchola AJ, Fullington H, Hughes AE, Hong Zhu, Pruitt SL. Nativity, ethnic enclave residence, and breast cancer survival among Latinas: Variations between California and Texas. Cancer 2020; 126:2849-2858. [PMID: 32181892 PMCID: PMC7245543 DOI: 10.1002/cncr.32845] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent. METHODS The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18 years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract. RESULTS Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes. CONCLUSIONS Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions.
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Affiliation(s)
- Salma Shariff-Marco
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA
| | - Scarlett Lin Gomez
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, CA
| | - Alison J. Canchola
- Greater Bay Area Cancer Registry, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA
| | - Hannah Fullington
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy E. Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hong Zhu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, Dallas, Texas, USA
| | - Sandi L. Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Cancer Center, Dallas, Texas, USA
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Medhanie GA, Fedewa SA, Adissu H, DeSantis CE, Siegel RL, Jemal A. Cancer incidence profile in sub-Saharan African-born blacks in the United States: Similarities and differences with US-born non-Hispanic blacks. Cancer 2017; 123:3116-3124. [PMID: 28407201 DOI: 10.1002/cncr.30701] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/28/2017] [Accepted: 03/07/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Sub-Saharan African-born blacks (ABs) are one of the fastest-growing populations in the United States. However, to the authors' knowledge, data regarding the cancer burden in this group are lacking, which would inform targeted cancer prevention and control. METHODS The authors calculated age-standardized proportional incidence ratios (PIRs) comparing the frequency of the top 15 cancers in ABs with that of US-born non-Hispanic blacks (USBs) by sex and region of birth using incidence data for 2000 through 2012 from the Surveillance, Epidemiology, and End Results (SEER 17) program. RESULTS Compared with USBs, ABs had significantly higher PIRs of infection-related cancers (liver, stomach, and Kaposi sarcoma), blood cancers (leukemia and non-Hodgkin lymphoma), prostate cancer, and thyroid cancers (females only). For example, the PIR for Kaposi sarcoma in AB versus USB women was 12.06 (95% confidence interval [95% CI], 5.23-18.90). In contrast, ABs had lower PIRs for smoking-related and colorectal cancers (eg, for lung cancer among men, the PIR was 0.30 [95% CI, 0.27-0.34]). Furthermore, cancer occurrence in ABs versus USBs varied by region of birth. For example, the higher PIRs for liver cancer noted among male ABs (PIR, 3.57; 95% CI, 1.79-5.35) and for thyroid cancer in female ABs (PIR, 3.03; 95% CI, 2.03-4.02) were confined to Eastern African-born blacks, whereas the higher PIR for prostate cancer (PIR, 1.90; 95% CI, 1.78, 2.02) was confined to Western African-born blacks. CONCLUSIONS The cancer incidence profile of ABs is different from that of USBs and varies by region of birth, suggesting differences in environmental, cultural, social, and genetic factors. The findings of the current study could stimulate etiologic research and help to inform targeted interventions. Cancer 2017;123:3116-24. © 2017 American Cancer Society.
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Affiliation(s)
- Genet A Medhanie
- Food Animal and Health Research Program, Ohio Agricultural Research and Development Center, The Ohio State University, Wooster, Ohio
| | - Stacey A Fedewa
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | | | - Carol E DeSantis
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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Pruitt SL, Tiro JA, Xuan L, Lee SJC. Hispanic and Immigrant Paradoxes in U.S. Breast Cancer Mortality: Impact of Neighborhood Poverty and Hispanic Density. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1238. [PMID: 27983668 PMCID: PMC5201379 DOI: 10.3390/ijerph13121238] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 12/26/2022]
Abstract
To test the Hispanic and Immigrant Paradoxes-i.e., survival advantages despite a worse risk factor profile-and the modifying role of neighborhood context, we examined associations between patient ethnicity, birthplace, neighborhood Hispanic density and neighborhood poverty among 166,254 female breast cancer patients diagnosed 1995-2009 in Texas, U.S. Of all, 79.9% were non-Hispanic White, 15.8% Hispanic U.S.-born, and 4.2% Hispanic foreign-born. We imputed birthplace for the 60.7% of Hispanics missing birthplace data using multiple imputation. Shared frailty Cox proportional hazard models (patients nested within census tracts) adjusted for age, diagnosis year, stage, grade, histology, urban/rural residence, and local mammography capacity. Whites (vs. U.S.-born Hispanics) had increased all-cause and breast cancer mortality. Foreign-born (vs. U.S.-born) Hispanics had increased all-cause and breast cancer mortality. Living in higher Hispanic density neighborhoods was generally associated with increased mortality, although associations differed slightly in magnitude and significance by ethnicity, birthplace, and neighborhood poverty. We found no evidence of an Immigrant Paradox and some evidence of a Hispanic Paradox where protective effects were limited to U.S.-born Hispanics. Contrary to prior studies, foreign birthplace and residence in higher Hispanic density neighborhoods were associated with increased mortality. More research on intersections between ethnicity, birthplace and neighborhood context are needed.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
| | - Lei Xuan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Simon J Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
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Kim JY, Winters JK, Kim J, Bernstein L, Raz D, Gomez SL. Birthplace and esophageal cancer incidence patterns among Asian-Americans. Dis Esophagus 2016; 29:99-104. [PMID: 25487184 PMCID: PMC5752430 DOI: 10.1111/dote.12302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The incidence of esophageal adenocarcinoma in the United States has risen rapidly over the last 30 years, whereas the incidence of esophageal squamous cell carcinoma has fallen dramatically. In contrast, parts of Asia have extremely high rates of squamous cell carcinoma, but virtually no adenocarcinoma. Within the United States, Asian-Americans as a whole, have low rates of esophageal adenocarcinoma and higher rates of squamous cell carcinoma. It is unclear what the patterns are for those Asians born in the United States. The relative influence of ethnicity and environment on the incidence of esophageal cancer in this population is unknown. We identified all cases of esophageal adenocarcinoma and squamous cell carcinoma from the California Cancer Registry 1988-2004, including 955 cases among 6 different Asian ethnicities. Time trends were examined using Joinpoint software to calculate the annual percentage changes in regression models. Rates of esophageal squamous cell carcinoma varied substantially among different Asian ethnic groups, but squamous cell carcinoma was much more common than adenocarcinoma in both foreign-born and US-born Asian-Americans. Rates of squamous cell carcinoma were slightly higher among US-born Asian men (4.0 per 100,000) compared with foreign-born Asian men (3.2 per 100,000) and White men (2.2 per 100,000), P = 0.03. Rates of adenocarcinoma were also slighter higher among US-born Asian men (1.2 per 100,000) compared with foreign-born Asian men (0.7 per 100,000), P = 0.01. Rates of squamous cell carcinoma decreased for both US-born and foreign-born Asians during this period, whereas adenocarcinoma remained low and stable. These results provide better insight into the genetic and environmental factors affecting the changing incidence of esophageal cancer histologies in the United States and Asia.
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Affiliation(s)
- J Y Kim
- Department of Surgery, City of Hope Cancer Center, Duarte, California, USA
| | - J K Winters
- Cancer Prevention Institute of California, Fremont, California, USA
| | - J Kim
- Department of Surgery, City of Hope Cancer Center, Duarte, California, USA
| | - L Bernstein
- Department of Surgery, City of Hope Cancer Center, Duarte, California, USA
| | - D Raz
- Department of Surgery, City of Hope Cancer Center, Duarte, California, USA
| | - S L Gomez
- Cancer Prevention Institute of California, Fremont, California, USA
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Corral JE, Delgado Hurtado JJ, Domínguez RL, Valdez de Cuéllar M, Balmore Cruz C, Morgan DR. The descriptive epidemiology of gastric cancer in Central America and comparison with United States Hispanic populations. J Gastrointest Cancer 2015; 46:21-8. [PMID: 25412859 DOI: 10.1007/s12029-014-9672-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aims of this study were to delineate the epidemiology of gastric adenocarcinoma in Central America and contrast it with Hispanic-Latino populations in the USA. METHODS Published literature and Central America Ministry of Health databases were used as primary data sources, including national, population-based, and hospital-based registries. US data was obtained from the National Cancer Institute (NCI)-Epidemiology End Results Program (SEER) registry. Incident gastric adenocarcinoma cases were analyzed for available data between 1985 and 2011, including demographic variables and pathology information. RESULTS In Central America, 19,741 incident gastric adenocarcinomas were identified. Two thirds of the cases were male, 20.5 % were under age 55, and 58.5 %were from rural areas. In the SEER database (n = 7871), 57.8 % were male and 28.9 % were under age 55. Among the US Hispanics born in Central America with gastric cancer (n = 1210), 50.3 % of cases were male and 38.1 % were under age 55. Non-cardia gastric cancer was more common in Central America (83.3 %), among US Hispanics (80.2 %), and Hispanics born in Central America (86.3 %). Cancers of the antrum were more common in Central America (73.6 %), whereas cancers of the corpus were slightly more common among US Hispanics (54.0 %). Adenocarcinoma of the diffuse subtype was relatively common, both in Central America (35.7 %) and US Hispanics (69.5 %), although Lauren classification was reported in only 50 % of cases. CONCLUSIONS A significant burden of gastric adenocarcinoma is observed in Central America based upon limited available data. Differences are noted between Central America and US Hispanics. Strengthening population-based registries is needed for improved cancer control in Central America, which may have implications for the growing US Hispanic population.
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Affiliation(s)
- Juan E Corral
- Department of Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, 1611 NW 12th Avenue Central Building, Room 600D (R-60), Miami, FL, 33136, USA,
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Gomez N, Guendelman S, Harley KG, Gomez SL. Nativity and neighborhood characteristics and cervical cancer stage at diagnosis and survival outcomes among Hispanic women in California. Am J Public Health 2015; 105:538-45. [PMID: 25602869 PMCID: PMC4330862 DOI: 10.2105/ajph.2014.302261] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined stage of diagnosis and survival after cervical cancer among Hispanic women, and their associations with Hispanic nativity, and explored whether neighborhood socioeconomic status (SES) and residence in a Hispanic enclave modify the association of nativity with stage and survival. METHODS We used California Cancer Registry data (1994-2009) to identify 7958 Hispanic women aged 21 years and older with invasive cervical cancer. We used logistic and Cox proportional hazards models to estimate the associations between stage and mortality with nativity, neighborhood factors, and other covariates. RESULTS Foreign-born women had similar adjusted relative odds of being diagnosed with stages II through IV (vs stage I) cervical cancer compared with US-born Hispanic women. However, among foreign-born women, those in low-SES-low-enclave neighborhoods were more likely to have late-stage disease than those in high-SES-low-enclave neighborhoods (adjusted odds ratio=1.91; 95% confidence interval=1.18, 3.07). Foreign-born women had lower cervical cancer mortality (adjusted hazard ratio=0.67; 95% confidence interval=0.58, 0.76) than US-born women, but only in high enclaves. CONCLUSIONS Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.
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Rodriguez AM, Schmeler KM, Kuo YF. Disparities in endometrial cancer outcomes between non-Hispanic White and Hispanic women. Gynecol Oncol 2014; 135:525-33. [DOI: 10.1016/j.ygyno.2014.10.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/20/2014] [Accepted: 10/21/2014] [Indexed: 01/18/2023]
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Pinheiro PS, Bungum TJ, Jin H. Limitations in the imputation strategy to handle missing nativity data in the Surveillance, Epidemiology, and End Results program. Cancer 2014; 120:3261-2. [PMID: 24962315 PMCID: PMC4356114 DOI: 10.1002/cncr.28866] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/05/2014] [Indexed: 01/14/2023]
Abstract
The proposed multiple imputation strategy for handling missing nativity data is affected by well established associations between stage at diagnosis, specified ethnicity, known birthplace, and survival.
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Affiliation(s)
- Paulo S. Pinheiro
- Epidemiology and Biostatistics, University of Nevada Las Vegas,
School of Community Health Sciences, (702) 895 5717
| | - Timothy J. Bungum
- Epidemiology and Biostatistics, University of Nevada Las Vegas,
School of Community Health Sciences, (702) 895 4986
| | - Hongbin Jin
- Epidemiology and Biostatistics, University of Nevada Las Vegas,
School of Community Health Sciences
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Froment MA, Gomez SL, Roux A, DeRouen MC, Kidd EA. Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California. Gynecol Oncol 2014; 133:409-15. [PMID: 24674831 PMCID: PMC5746172 DOI: 10.1016/j.ygyno.2014.03.559] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study aimed to evaluate the incidence of cervical cancer by nativity [United States (US) versus non-US], neighborhood socioeconomic status and ethnic enclave among Hispanics and Asians in California. METHODS Using data from the California Cancer Registry, information on all primary invasive cervical cancer (Cca) patients diagnosed in California from January 1, 1990 through December 31, 2004 was obtained. We analyzed the influence of enclave, socioeconomic status and nativity on Cca incidence. RESULTS Among the 22,189 Cca cases diagnosed between 1990 and 2004, 50% were non-Hispanic white, 39% Hispanic and 11% Asian women, and 63% US-born. Seventy percent of the Cca cases were squamous cell carcinoma, 19% adenocarcinoma and 11% other histologies. Higher incidence of Cca was observed in high enclave (76%) and low socioeconomic status (70%) neighborhoods. By ethnic group, US-born women showed lower rates of squamous cell carcinoma compared to foreign-born women. Hispanics living in low socioeconomic and high enclave had 12.7 times higher rate of Cca than those living in high socioeconomic, low enclave neighborhoods. For Asian women incidence rates were 6 times higher in the low socioeconomic, high enclave neighborhoods compared to those living in high socioeconomic, low enclave neighborhoods. CONCLUSION More targeted outreach to increase Pap smear screening and human papilloma virus vaccination for women living in high enclave neighborhoods can help decrease the incidence of Cca in these groups of women.
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Affiliation(s)
- Marie-Anne Froment
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA.
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, CA, USA; Department of Health Research and Policy, School of Medicine, Stanford, CA, USA
| | - Audrey Roux
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
| | | | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA
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Ladabaum U, Clarke CA, Press DJ, Mannalithara A, Myer PA, Cheng I, Gomez SL. Colorectal cancer incidence in Asian populations in California: effect of nativity and neighborhood-level factors. Am J Gastroenterol 2014; 109:579-88. [PMID: 24492754 PMCID: PMC5746419 DOI: 10.1038/ajg.2013.488] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 12/20/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Heritable and environmental factors may contribute to differences in colorectal cancer (CRC) incidence across populations. We capitalized on the resources of the California Cancer Registry (CCR) and California's diverse Asian population to perform a cohort study exploring the relationships between CRC incidence, nativity, and neighborhood-level factors across Asian subgroups. METHODS We identified CRC cases in the CCR from 1990 to 2004 and calculated age-adjusted CRC incidence rates for non-Hispanic Whites and US-born vs. foreign-born Asian ethnic subgroups, stratified by neighborhood socioeconomic status (SES) and "ethnic enclave." Trends were studied with joinpoint analysis. RESULTS CRC incidence was lowest among foreign-born South Asians (22.0/100,000; 95% confidence interval (CI): 19.7-24.5/100,000) and highest among foreign-born Japanese (74.6/100,000; 95% CI: 70.1-79.2/100,000). Women in all Asian subgroups except Japanese, and men in all Asian subgroups except Japanese and US-born Chinese, had lower CRC incidence than non-Hispanic Whites. Among Chinese men and Filipino women and men, CRC incidence was lower among foreign-born than US-born persons; the opposite was observed for Japanese women and men. Among non-Hispanic Whites, but not most Asian subgroups, CRC incidence decreased over time. CRC incidence was inversely associated with neighborhood SES among non-Hispanic Whites, and level of ethnic enclave among Asians. CONCLUSIONS CRC incidence rates differ substantially across Asian subgroups in California. The significant associations between CRC incidence and nativity and residence in an ethnic enclave suggest a substantial effect of acquired environmental factors. The absence of declines in CRC incidence rates among most Asians during our study period may point to disparities in screening compared with Whites.
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Affiliation(s)
- Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christina A. Clarke
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Cancer Prevention Institute of California, Fremont, California, USA
| | - David J. Press
- Cancer Prevention Institute of California, Fremont, California, USA
| | - Ajitha Mannalithara
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Parvathi A. Myer
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California, USA
| | - Scarlett Lin Gomez
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Cancer Prevention Institute of California, Fremont, California, USA
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Montealegre JR, Zhou R, Amirian ES, Scheurer ME. Uncovering nativity disparities in cancer patterns: Multiple imputation strategy to handle missing nativity data in the Surveillance, Epidemiology, and End Results data file. Cancer 2014; 120:1203-11. [PMID: 24436157 DOI: 10.1002/cncr.28533] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 10/22/2013] [Accepted: 11/12/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although birthplace data are routinely collected in the participating Surveillance, Epidemiology, and End Results (SEER) registries, such data are missing in a nonrandom manner for a large percentage of cases. This hinders analysis of nativity-related cancer disparities. In the current study, the authors evaluated multiple imputation of nativity status among Hispanic patients diagnosed with cervical, prostate, and colorectal cancer and demonstrated the effect of multiple imputation on apparent nativity disparities in survival. METHODS Multiple imputation by logistic regression was used to generate nativity values (US-born vs foreign-born) using a priori-defined variables. The accuracy of the method was evaluated among a subset of cases. Kaplan-Meier curves were used to illustrate the effect of imputation by comparing survival among US-born and foreign-born Hispanics, with and without imputation of nativity. RESULTS Birthplace was missing for 31%, 49%, and 39%, respectively, of cases of cervical, prostate, and colorectal cancer. The sensitivity of the imputation strategy for detecting foreign-born status was ≥90% and the specificity was ≥86%. The agreement between the true and imputed values was ≥0.80 and the misclassification error was ≤10%. Kaplan-Meier survival curves indicated different associations between nativity and survival when nativity was imputed versus when cases with missing birthplace were omitted from the analysis. CONCLUSIONS Multiple imputation using variables available in the SEER data file can be used to accurately detect foreign-born status. This simple strategy may help researchers to disaggregate analyses by nativity and uncover important nativity disparities in regard to cancer diagnosis, treatment, and survival.
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Affiliation(s)
- Jane R Montealegre
- Division, of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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12
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Pinheiro PS, Bungum TJ. Country of origin and breast cancer survival. Asia Pac J Clin Oncol 2013; 10:279. [PMID: 24261991 DOI: 10.1111/ajco.12161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paulo S Pinheiro
- Environmental and Occupational Health Department - Epidemiology and Biostatistics, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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Montealegre JR, Zhou R, Amirian ES, Follen M, Scheurer ME. Nativity disparities in late-stage diagnosis and cause-specific survival among Hispanic women with invasive cervical cancer: an analysis of Surveillance, Epidemiology, and End Results data. Cancer Causes Control 2013; 24:1985-94. [PMID: 23934001 PMCID: PMC4115245 DOI: 10.1007/s10552-013-0274-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 07/31/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE While cervical cancer screening and risk behaviors have been found to vary among US- and foreign-born Hispanic women, many cancer epidemiology studies have conceptualized Hispanics as a homogenous group. Here, we examine differences in cervical cancer stage at diagnosis and survival among Hispanic women by nativity. METHODS We use data from the Surveillance, Epidemiology, and End Results program, 1998-2008. Nativity was based on place of birth and was categorized as US versus foreign born. Distant and regional tumors were classified as late stage, while local tumors were classified as early stage. RESULTS Forty-seven percent of cases of invasive cervical cancer among Hispanics were diagnosed at a late stage, and over half of invasive cervical cancer cases were among foreign-born women. Foreign-born Hispanic women were significantly more likely than US-born Hispanics to have late-stage diagnosis, after adjusting for age at diagnosis and tumor histology (adjusted odds ration = 1.09, p value = 0.003). There was heterogeneity in the association between nativity and survival by stage at diagnosis. Among cases with early-stage diagnosis, survival was poorer among foreign-born versus US-born Hispanics after adjusting for age at diagnosis, histology, and cancer-directed therapy [adjusted hazard ratios (HR) = 1.31, p value = 0.030]. However, among cases with late-stage diagnosis, survival was better among foreign-born Hispanics (adjusted HR = 0.81, p value < 0.001). CONCLUSIONS We hypothesize that nativity differences in survival may be indicative of diverse risk, screening, and treatment profiles. Given such differences, it may be inappropriate to aggregate Hispanics as a single group for cervical cancer research.
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Affiliation(s)
- Jane R Montealegre
- Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA,
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Singh GK, Rodriguez-Lainz A, Kogan MD. Immigrant health inequalities in the United States: use of eight major national data systems. ScientificWorldJournal 2013; 2013:512313. [PMID: 24288488 PMCID: PMC3826317 DOI: 10.1155/2013/512313] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/23/2013] [Indexed: 11/17/2022] Open
Abstract
Eight major federal data systems, including the National Vital Statistics System (NVSS), National Health Interview Survey (NHIS), National Survey of Children's Health, National Longitudinal Mortality Study, and American Community Survey, were used to examine health differentials between immigrants and the US-born across the life course. Survival and logistic regression, prevalence, and age-adjusted death rates were used to examine differentials. Although these data systems vary considerably in their coverage of health and behavioral characteristics, ethnic-immigrant groups, and time periods, they all serve as important research databases for understanding the health of US immigrants. The NVSS and NHIS, the two most important data systems, include a wide range of health variables and many racial/ethnic and immigrant groups. Immigrants live 3.4 years longer than the US-born, with a life expectancy ranging from 83.0 years for Asian/Pacific Islander immigrants to 69.2 years for US-born blacks. Overall, immigrants have better infant, child, and adult health and lower disability and mortality rates than the US-born, with immigrant health patterns varying across racial/ethnic groups. Immigrant children and adults, however, fare substantially worse than the US-born in health insurance coverage and access to preventive health services. Suggestions and new directions are offered for improvements in health monitoring and for strengthening and developing databases for immigrant health assessment in the USA.
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Affiliation(s)
- Gopal K. Singh
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA
| | - Alfonso Rodriguez-Lainz
- Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 3851 Rosecrans Street, Mailstop P575, Suite 715, San Diego, CA 92110, USA
| | - Michael D. Kogan
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, 5600 Fishers Lane, Room 18-41, Rockville, MD 20857, USA
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Patel MI, Schupp CW, Gomez SL, Chang ET, Wakelee HA. How do social factors explain outcomes in non-small-cell lung cancer among Hispanics in California? Explaining the Hispanic paradox. J Clin Oncol 2013; 31:3572-8. [PMID: 23960183 PMCID: PMC3782149 DOI: 10.1200/jco.2012.48.6217] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Hispanics in the United States have lower age-adjusted mortality resulting from non-small-cell lung cancer (NSCLC) compared with non-Hispanic whites (NHWs). The purpose of this study was to evaluate individual, clinical, and neighborhood factors in survival among Hispanics with NSCLC. PATIENTS AND METHODS We performed a retrospective analysis of NHWs and Hispanics with NSCLC between 1998 and 2007 in the California Cancer Registry (follow-up to December 2009). Kaplan-Meier curves depict survival by nativity for Hispanics with NSCLC. Cox proportional hazards models estimated hazard of mortality by race with adjustment for individual (age, sex, marital status), clinical (histologic grade, surgery, irradiation, chemotherapy), and neighborhood factors (neighborhood socioeconomic status, ethnic enclave). RESULTS We included 14,280 Hispanic patients with NSCLC. Foreign-born Hispanics had 15% decreased risk of disease-specific mortality resulting from NSCLC compared with NHWs (hazard ratio [HR], 0.85; 95% CI, 0.83 to 0.88) after adjustment for individual, clinical, and neighborhood factors. After adjustment for individual factors, compared with US-born Hispanics, foreign-born Hispanics had 10% decreased risk of disease-specific mortality (HR, 0.90; 95% CI, 0.87 to 0.96). Clinical and neighborhood factors slightly moderated the survival benefit for foreign-born patients. A modestly more pronounced survival advantage was seen for foreign-born Hispanics living in low socioeconomic and high Hispanic enclave neighborhoods as compared with US-born Hispanics (HR, 0.86; 95% CI, 0.81 to 0.90). CONCLUSION Foreign-born Hispanics with NSCLC have a decreased risk of disease-specific mortality compared with NHWs and US-born Hispanics with NSCLC. Neighborhood factors slightly moderate this survival advantage. This survival advantage is slightly more pronounced in lower socioeconomic and higher Hispanic enclave neighborhoods.
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MESH Headings
- Adenocarcinoma/ethnology
- Adenocarcinoma/mortality
- Adenocarcinoma/therapy
- Adenocarcinoma, Bronchiolo-Alveolar/ethnology
- Adenocarcinoma, Bronchiolo-Alveolar/mortality
- Adenocarcinoma, Bronchiolo-Alveolar/therapy
- Aged
- California
- Carcinoma, Large Cell/ethnology
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/therapy
- Carcinoma, Non-Small-Cell Lung/ethnology
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Squamous Cell/ethnology
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/therapy
- Combined Modality Therapy
- Ethnicity
- Female
- Follow-Up Studies
- Hispanic or Latino/statistics & numerical data
- Humans
- Lung Neoplasms/ethnology
- Lung Neoplasms/mortality
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Grading
- Prognosis
- Registries
- Residence Characteristics
- Retrospective Studies
- Risk Factors
- Social Class
- Survival Rate
- White People/statistics & numerical data
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Affiliation(s)
- Manali I. Patel
- Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA
| | - Clayton W. Schupp
- Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA
| | - Scarlett L. Gomez
- Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA
| | - Ellen T. Chang
- Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA
| | - Heather A. Wakelee
- Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA
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Gomez SL, Press DJ, Lichtensztajn D, Keegan THM, Shema SJ, Le GM, Kurian AW. Patient, hospital, and neighborhood factors associated with treatment of early-stage breast cancer among Asian American women in California. Cancer Epidemiol Biomarkers Prev 2012; 21:821-34. [PMID: 22402290 PMCID: PMC3406750 DOI: 10.1158/1055-9965.epi-11-1143] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Clinical guidelines recommend breast-conserving surgery (BCS) with radiation as a viable alternative to mastectomy for treatment of early-stage breast cancer. Yet, Asian Americans are more likely than other groups to have mastectomy or omit radiation after BCS. METHODS We applied polytomous logistic regression and recursive partitioning to analyze factors associated with mastectomy, or BCS without radiation, among 20,987 California Asian Americans diagnosed with stage 0 to II breast cancer from 1990 to 2007. RESULTS The percentage receiving mastectomy ranged from 40% among U.S.-born Chinese to 58% among foreign-born Vietnamese. Factors associated with mastectomy included tumor characteristics such as larger tumor size, patient characteristics such as older age and foreign birthplace among some Asian Americans ethnicities, and additional factors including hospital [smaller hospital size, not National Cancer Institute cancer center, low socioeconomic status (SES) patient composition, and high hospital Asian Americans patient composition] and neighborhood characteristics (ethnic enclaves of low SES). These hospital and neighborhood characteristics were also associated with BCS without radiation. Through recursive partitioning, the highest mastectomy subgroups were defined by tumor characteristics such as size and anatomic location, in combination with diagnosis year and nativity. CONCLUSIONS Tumor characteristics and, secondarily, patient, hospital, and neighborhood factors are predictors of mastectomy and omission of radiation following BCS among Asian Americans. IMPACT By focusing on interactions among patient, hospital, and neighborhood factors in the differential receipt of breast cancer treatment, our study identifies subgroups of interest for further study and translation into public health and patient-focused initiatives to ensure that all women are fully informed about treatment options.
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Clarke CA, Glaser SL, Gomez SL, Wang SS, Keegan TH, Yang J, Chang ET. Lymphoid malignancies in U.S. Asians: incidence rate differences by birthplace and acculturation. Cancer Epidemiol Biomarkers Prev 2011; 20:1064-77. [PMID: 21493873 PMCID: PMC3111874 DOI: 10.1158/1055-9965.epi-11-0038] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHL), HL, and multiple myeloma, occur at much lower rates in Asians than other racial/ethnic groups in the United States. It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status. METHODS We obtained data about all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from U.S. Census data. RESULTS Although incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than U.S.-born Asians with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower SES neighborhoods than those living elsewhere. CONCLUSIONS These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL. IMPACT Studying specific lymphoid malignancies in U.S. Asians may provide valuable insight toward understanding their environmental causes.
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Affiliation(s)
- Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California 94538, USA.
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McDonald JT, Neily J. Race, immigrant status, and cancer among women in the United States. J Immigr Minor Health 2011; 13:27-35. [PMID: 19521768 DOI: 10.1007/s10903-009-9268-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on the incidence of cancer among the immigrant population has tended to be of quite a limited scope. We investigate whether immigrant women in the US are less likely to have been recently diagnosed with cancer, and what factors might help to explain any differences identified. We estimate multivariate Logistic regression models to identify the determinants of a diagnosis within the last 3 years of any cancer, of breast cancer and of cervical cancer as well as the use of cancer screening by US women, using self-reported information on cancer diagnosis from consecutive waves of the US National Health Interview Survey over the years 1998-2007. Immigrant women of different ethnic groups are less likely to have been diagnosed with cancer, breast cancer and cervical cancer compared to US-born women. The use of basic health services, including cancer screening, is also lower for immigrant women for each main ethnic group. More research is required to determine whether immigrants may face delays in timely diagnosis of cancer by health care professionals.
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Affiliation(s)
- James Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, NB, E3B5A3, Canada.
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19
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Horn-Ross PL, McClure LA, Chang ET, Clarke CA, Keegan THM, Rull RP, Quach T, Gomez SL. Papillary thyroid cancer incidence rates vary significantly by birthplace in Asian American women. Cancer Causes Control 2011; 22:479-85. [PMID: 21207130 DOI: 10.1007/s10552-010-9720-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women. METHODS Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988-2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women. RESULTS Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR = 0.48, 95% CI: 0.40-0.59) and Filipina women (IRR = 0.74, 95% CI: 0.58-0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR = 1.55, 95% CI: 1.17-2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident. CONCLUSIONS Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.
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Affiliation(s)
- Pamela L Horn-Ross
- Cancer Prevention Institute of California, 2201 Walnut Ave., Suite 300, Fremont, CA 94538, USA.
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20
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Nielsen SS, He Y, Ayanian JZ, Gomez SL, Kahn KL, West DW, Keating NL. Quality of cancer care among foreign-born and US-born patients with lung or colorectal cancer. Cancer 2010; 116:5497-506. [PMID: 20672356 PMCID: PMC2974942 DOI: 10.1002/cncr.25546] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Disparities in care have been documented for foreign-born cancer patients in the United States. However, few data are available regarding patients with lung and colorectal cancer. In the current study, the authors assessed whether patient-reported quality and receipt of recommended care differed between US-born and foreign-born cancer patients. METHODS The authors collected surveys and medical records for a population-based cohort including white, Hispanic, and Asian adults (2205 US-born and 890 foreign-born individuals) with lung or colorectal cancer diagnosed in California from 2003 through 2005. Logistic regression was used to assess the association between nativity and patient-reported quality of care and receipt of recommended treatments (adjuvant chemotherapy for stage III colon cancer, adjuvant chemotherapy and radiotherapy for stage II/III rectal cancer, and curative surgery for stage I/II nonsmall cell lung cancer). The authors also assessed whether language explained any differences in care by nativity. RESULTS Overall, 46% of patients reported excellent care, but foreign-born patients were less likely than US-born patients to report excellent quality of care (adjusted odds ratio [AOR], 0.80; 95% confidence interval [95% CI], 0.65-1.00), a difference partly explained by the language of the survey, an indicator of English proficiency. Rates of recommended therapies ranged from 64% to 85%; foreign-born patients were less likely to receive chemotherapy and radiotherapy for stage II/III rectal cancer (AOR, 0.35; 95% CI, 0.12-0.99). Rates of other treatments did not differ significantly by nativity. CONCLUSIONS Foreign-born cancer patients reported lower quality of care and were less likely to receive some cancer therapies than patients born in the Unites States. Better coordination of care and communication regarding cancer treatments and expanded use of interpreters may lessen these disparities.
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Affiliation(s)
- Signe Smith Nielsen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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21
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Keegan THM, Quach T, Shema S, Glaser SL, Gomez SL. The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women. BMC Cancer 2010; 10:603. [PMID: 21050464 PMCID: PMC2988754 DOI: 10.1186/1471-2407-10-603] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 11/04/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the US, foreign-born Hispanics tend to live in socioeconomic conditions typically associated with later stage of breast cancer diagnosis, yet they have lower breast cancer mortality rates than their US-born counterparts. We evaluated the impact of nativity (US- versus foreign-born), neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants) on breast cancer stage at diagnosis and survival among Hispanics. METHODS We studied 37,695 Hispanic women diagnosed from 1988 to 2005 with invasive breast cancer from the California Cancer Registry. Nativity was based on registry data or, if missing, imputed from case Social Security number. Neighborhood variables were developed from Census data. Stage at diagnosis was analyzed with logistic regression, and survival, based on vital status determined through 2007, was analyzed with Cox proportional hazards regression. RESULTS Compared to US-born Hispanics, foreign-born Hispanics were more likely to be diagnosed at an advanced stage of breast cancer (adjusted odds ratio (OR) = 1.14, 95% confidence interval (CI): 1.09-1.20), but they had a somewhat lower risk of breast cancer specific death (adjusted hazard ratio (HR) = 0.94, 95% CI: 0.90-0.99). Living in low SES and high enclave neighborhoods was associated with advanced stage of diagnosis, while living in a lower SES neighborhood, but not Hispanic enclave, was associated with worse survival. CONCLUSION Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.
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Chang ET, Yang J, Alfaro-Velcamp T, So SKS, Glaser SL, Gomez SL. Disparities in liver cancer incidence by nativity, acculturation, and socioeconomic status in California Hispanics and Asians. Cancer Epidemiol Biomarkers Prev 2010; 19:3106-18. [PMID: 20940276 DOI: 10.1158/1055-9965.epi-10-0863] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Asians and Hispanics have the highest incidence rates of liver cancer in the United States, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring. METHODS Incidence rates and rate ratios (IRR) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988-2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 U.S. Census data for cases diagnosed in 1998-2002. RESULTS Foreign-born Hispanic males had significantly lower liver cancer incidence rates than U.S.-born Hispanic males in 1988-2004 (e.g., IRR = 0.54, 95% confidence interval [CI] = 0.50-0.59 in 1997-2004), whereas foreign-born Hispanic females had significantly higher rates in 1988-1996 (IRR = 1.42, 95% CI = 1.18-1.71), but not 1997-2004. Foreign-born Asian males and females had up to 5-fold higher rates than the U.S.-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates. CONCLUSIONS Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention. IMPACT Liver cancer control efforts should especially target foreign-born Asians, U.S.-born Hispanic men, and residents of lower-SES ethnic enclaves.
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Affiliation(s)
- Ellen T Chang
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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Gomez SL, Clarke CA, Shema SJ, Chang ET, Keegan THM, Glaser SL. Disparities in breast cancer survival among Asian women by ethnicity and immigrant status: a population-based study. Am J Public Health 2010; 100:861-9. [PMID: 20299648 DOI: 10.2105/ajph.2009.176651] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We investigated heterogeneity in ethnic composition and immigrant status among US Asians as an explanation for disparities in breast cancer survival. METHODS We enhanced data from the California Cancer Registry and the Surveillance, Epidemiology, and End Results program through linkage and imputation to examine the effect of immigrant status, neighborhood socioeconomic status, and ethnic enclave on mortality among Chinese, Japanese, Filipino, Korean, South Asian, and Vietnamese women diagnosed with breast cancer from 1988 to 2005 and followed through 2007. RESULTS US-born women had similar mortality rates in all Asian ethnic groups except the Vietnamese, who had lower mortality risk (hazard ratio [HR] = 0.3; 95% confidence interval [CI] = 0.1, 0.9). Except for Japanese women, all foreign-born women had higher mortality than did US-born Japanese, the reference group. HRs ranged from 1.4 (95% CI = 1.2, 1.7) among Koreans to 1.8 (95% CI = 1.5, 2.2) among South Asians and Vietnamese. Little of this variation was explained by differences in disease characteristics. CONCLUSIONS Survival after breast cancer is poorer among foreign- than US-born Asians. Research on underlying factors is needed, along with increased awareness and targeted cancer control.
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Affiliation(s)
- Scarlett Lin Gomez
- Northern California Cancer Center, 2201 Walnut Ave, Suite 300, Fremont, CA 94538, USA.
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Kristiansen M, Hassani A, Krasnik A. A qualitative assessment of implementing a cross-cultural survey on cancer wards in Denmark--a description of barriers. BMC Med Res Methodol 2010; 10:4. [PMID: 20067615 PMCID: PMC2820029 DOI: 10.1186/1471-2288-10-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 01/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research into migration and health is often confronted with methodological challenges related to the identification of migrants in various settings. Furthermore, it is often difficult to reach an acceptable level of participation among migrant groups in quantitative research. The aim of this study is to conduct a qualitative assessment of the barriers encountered during the implementation of a cross-cultural survey on cancer wards in Copenhagen, Denmark. METHODS Participant observation at the involved wards was combined with qualitative interviews with selected nurses and informal talks with a wider group of nurses at the wards involved in the survey. RESULTS One possible way to increase the participation of migrant patients in research is through the involvement of the hospital staff in contact with patients. Involvement of nurses on cancer wards in the delivery of questionnaires to patients was challenging, despite a general willingness to participate in psychosocial research. The main difficulties were found to be both external (policy changes, general strike among nurses) and internal on the wards (heavy workload, lack of time, focus on medical aspects of cancer rather than psychosocial aspects). These factors interacted and resulted in a lower priority being given to psychosocial research. Further, nurses expressed a feeling that researchers in general did not recognize their contribution in research, making it more difficult to engage fully in studies. CONCLUSIONS Involving hospital staff in research is feasible but not straightforward. Awareness of the influence of possible external and internal factors and efforts to deal with these factors are fundamental to the successful implementation of psychosocial cancer research in a hospital setting.
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Affiliation(s)
- Maria Kristiansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Byfield SAD, Earle CC, Ayanian JZ, McCarthy EP. Treatment and outcomes of gastric cancer among United States-born and foreign-born Asians and Pacific Islanders. Cancer 2009; 115:4595-605. [PMID: 19626648 PMCID: PMC2953712 DOI: 10.1002/cncr.24487] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The authors investigated whether stage at diagnosis, cancer treatments, and survival of Asian and Pacific Islander (API) gastric cancer patients in the United States vary by birthplace. METHODS The authors studied 6454 API and 10,099 non-Hispanic white (NHW) patients diagnosed with gastric cancer from the Surveillance, Epidemiology, and End Results program between 1992 and 2005. In descriptive analyses, stage, receipt of adequate lymph node examination (ALNE), and surgery were compared among US-born APIs, foreign-born (FB) APIs, and NHWs. Multivariate polytomous logistic and proportional hazards regression models were used to assess differences in cancer stage and survival, respectively, adjusted for clinical and demographic factors. RESULTS As a group, APIs were more likely than NHWs to present with earlier-stage diagnoses and receive surgery and ALNE (P < .001). However, FB (adjusted odds ratios [aOR], 0.79; 95% confidence interval [CI], 0.73-0.86) but not US-born APIs (aOR, 1.05; 95% CI, 0.92-1.20) were significantly more likely to present at earlier stages than NHWs. Compared with NHW patients, FB and US-born APIs were more likely to receive surgery (adjusted risk ratio [aRR], 1.06; 95% CI, 1.03-1.09 and aRR, 1.09; 95% CI, 1.03-1.14, respectively) and ALNE (aRR, 1.29; 95% CI, 1.19-1.41 and aRR, 1.14; 95% CI, 1.00-1.32, respectively). In fully adjusted models, FB (adjusted relative hazard ratios [aHR], 0.86; 95% CI, 0.82-0.90) but not US-born APIs (aHR, 0.96; 95% CI, 0.89-1.04) had more favorable survival than NHWs. CONCLUSIONS The earlier-stage diagnosis, more complete surgical treatment, and improved survival of Asians and Pacific Islanders with gastric cancer may result from less aggressive tumors or more prompt recognition and thorough evaluation of early symptoms. Further study of these factors could improve outcomes for all patients with gastric cancer.
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Affiliation(s)
- Stacey A Dacosta Byfield
- Division of Pharmacy, Department of Drug Use Policy and Pharmacoeconomics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Mexican immigrant male knowledge and support toward breast and cervical cancer screening. J Immigr Minor Health 2008; 11:326-33. [PMID: 18551367 DOI: 10.1007/s10903-008-9161-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Accepted: 05/27/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. METHODS Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. RESULTS Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. CONCLUSION Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.
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Gany FM, Shah SM, Changrani J. New York City's immigrant minorities. Reducing cancer health disparities. Cancer 2007; 107:2071-81. [PMID: 16983657 DOI: 10.1002/cncr.22155] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign-born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community- and faith-based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant-service and advocacy organizations. This community-based participatory program chose as its priorities high- incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at-risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006. (c) 2006 American Cancer Society.
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Affiliation(s)
- Francesca M Gany
- Center for Immigrant Health, New York University School of Medicine, New York, New York 10016, USA.
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Clegg LX, Reichman ME, Hankey BF, Miller BA, Lin YD, Johnson NJ, Schwartz SM, Bernstein L, Chen VW, Goodman MT, Gomez SL, Graff JJ, Lynch CF, Lin CC, Edwards BK. Quality of race, Hispanic ethnicity, and immigrant status in population-based cancer registry data: implications for health disparity studies. Cancer Causes Control 2007; 18:177-87. [PMID: 17219013 DOI: 10.1007/s10552-006-0089-4] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 10/28/2006] [Indexed: 11/26/2022]
Abstract
Population-based cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) Program at the National Cancer Institute are based on medical records and administrative information. Although SEER data have been used extensively in health disparities research, the quality of information concerning race, Hispanic ethnicity, and immigrant status has not been systematically evaluated. The quality of this information was determined by comparing SEER data with self-reported data among 13,538 cancer patients diagnosed between 1973-2001 in the SEER--National Longitudinal Mortality Study linked database. The overall agreement was excellent on race (kappa = 0.90, 95% CI = 0.88-0.91), moderate to substantial on Hispanic ethnicity (kappa = 0.61, 95% CI = 0.58-0.64), and low on immigrant status (kappa = 0.21. 95% CI = 0.10, 0.23). The effect of these disagreements was that SEER data tended to under-classify patient numbers when compared to self-identifications, except for the non-Hispanic group which was slightly over-classified. These disagreements translated into varying racial-, ethnic-, and immigrant status-specific cancer statistics, depending on whether self-reported or SEER data were used. In particular, the 5-year Kaplan-Meier survival and the median survival time from all causes for American Indians/Alaska Natives were substantially higher when based on self-classification (59% and 140 months, respectively) than when based on SEER classification (44% and 53 months, respectively), although the number of patients is small. These results can serve as a useful guide to researchers contemplating the use of population-based registry data to ascertain disparities in cancer burden. In particular, the study results caution against evaluating health disparities by using birthplace as a measure of immigrant status and race information for American Indians/Alaska Natives.
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Affiliation(s)
- Limin X Clegg
- Office of Healthcare Inspections, Office of Inspector General, US Department of Veterans Affairs, Washington, DC 20001, USA.
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Gomez SL, Glaser SL. Misclassification of race/ethnicity in a population-based cancer registry (United States). Cancer Causes Control 2006; 17:771-81. [PMID: 16783605 DOI: 10.1007/s10552-006-0013-y] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Revised: 01/18/2006] [Indexed: 10/24/2022]
Abstract
Cancer registry data on race/ethnicity are vital for understanding cancer patterns in population subgroups, as they inform public health policies for allocating resources and form the bases of etiologic hypotheses. However, accuracy of cancer registry data on race/ethnicity has not been systematically evaluated. By comparing race/ethnicity in the Greater Bay Area Cancer Registry to self-reported race/ethnicity for patients from 14 racial/ethnic groups, we determined the accuracy of this variable and the patient and hospital characteristics associated with disagreement. The extent of misclassification (measured by sensitivity and predictive value positive (PV+)) varied across racial/ethnic groups (total n=11,676). Sensitivities and PV+'s were high (exceeding 90%) for non-Hispanic Whites and Blacks, moderate for Hispanics and some Asian subgroups (70-90%), and very low for American Indians (<20%). Overall, registry and interview race/ethnicity disagreed for 11% of the sample. In a multivariate model, disagreement was associated with non-White race/ethnicity, younger age, being married, being foreign-born but preferring to speak English, and diagnosis in a large hospital. Improving data quality for race/ethnicity will be most effectively attempted at the reporting source. We advocate a concerted effort to systematize collection of these patient data across all facilities, which may be more feasible given electronic medical admissions forms.
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Affiliation(s)
- Scarlett L Gomez
- Northern California Cancer Center, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA.
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Changrani J, Gany FM, Cruz G, Kerr R, Katz R. Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City. JOURNAL OF IMMIGRANT & REFUGEE STUDIES 2006; 4. [PMID: 17492057 PMCID: PMC1867456 DOI: 10.300/j500v04n01_07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S.A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% arc current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer.Between the two communities, there were significant differences in paan and gutfca usage, migration effects, and oral career risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products.
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Affiliation(s)
- Jyotsna Changrani
- Jyotsna Changrani, MD, MPH, is affiliated with the Center for Immigrant Health, New York University School of Medicine, OBV-D-402,550 First Avenue, New York, NY 10016
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Changrani J, Gany FM, Cruz G, Kerr R, Katz R. Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City. JOURNAL OF IMMIGRANT & REFUGEE STUDIES 2006; 4:99-110. [PMID: 17492057 PMCID: PMC1867456 DOI: 10.1300/j500v04n01_07] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S.A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% arc current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer.Between the two communities, there were significant differences in paan and gutfca usage, migration effects, and oral career risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products.
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Affiliation(s)
- Jyotsna Changrani
- Jyotsna Changrani, MD, MPH, is affiliated with the Center for Immigrant Health, New York University School of Medicine, OBV-D-402,550 First Avenue, New York, NY 10016
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Goel MS, Burns RB, Phillips RS, Davis RB, Ngo-Metzger Q, McCarthy EP. Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992-2000. J Gen Intern Med 2005; 20:604-11. [PMID: 16050854 PMCID: PMC1490151 DOI: 10.1111/j.1525-1497.2005.0090.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breast-conserving surgery (BCS) has been the recommended treatment for early-stage breast cancer since 1990 yet many women still do not receive this procedure. OBJECTIVE To examine the relationship between birthplace and use of BCS in Asian-American and Pacific-Islander (AAPI) women, and to determine whether disparities between white and AAPI women persist over time. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Women with newly diagnosed stage I or II breast cancer from 1992 to 2000 in the Surveillance, Epidemiology, and End Results program. OUTCOME Receipt of breast -conserving surgery for initial treatment of stage I or II breast cancer. MAIN RESULTS Overall, AAPI women had lower rates of BCS than white women (47% vs 59%; P<.01). Foreign-born AAPI women had lower rates of BCS than U.S.-born AAPI and white women (43% vs 56% vs 59%; P<.01). After adjustment for age, marital status, tumor registry, year of diagnosis, stage at diagnosis, tumor size, histology, grade, and hormone receptor status, foreign-born AAPI women (adjusted OR [aOR], 0.49; 95% CI, 0.32 to 0.76) and U.S.-born AAPI women (aOR, 0.77; 95% CI, 0.62 to 0.95) had lower odds of receiving BCS than white women. Use of BCS increased over time for each racial/ethnic group; however, foreign-born AAPI women had persistently lower rates of BCS than non-Hispanic white women. CONCLUSIONS AAPI women, especially those who are foreign born, are less likely to receive BCS than non-Hispanic white women. Of particular concern, differences in BCS use among foreign-born and U.S.-born AAPI women and non-Hispanic white women have persisted over time. These differences may reflect inequities in the treatment of early-stage breast cancer for AAPI women, particularly those born abroad.
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Affiliation(s)
- Mita Sanghavi Goel
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Gomez SL, Le GM, West DW, Satariano WA, O'Connor L. Hospital policy and practice regarding the collection of data on race, ethnicity, and birthplace. Am J Public Health 2003; 93:1685-8. [PMID: 14534222 PMCID: PMC1448034 DOI: 10.2105/ajph.93.10.1685] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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