How do social factors explain outcomes in non-small cell lung cancer among Hispanics/Latinos in California?

Abstract

6050 Background: Hispanics in the United States have a lower age-adjusted incidence and mortality rate from non-small cell lung cancer compared with non-Hispanic whites. Previous studies have demonstrated the influence of nativity on survival among Hispanic patients but no studies have evaluated the interplay of nativity, clinical factors, social factors, and neighborhood factors on survival among Hispanic patients with non-small cell lung cancer. Methods: All Hispanic patients with non-small cell lung cancer between the years of 1988-2008 were identified in the California Cancer Registry (CCR). Kaplan Meier curves depict survival by nativity status among Hispanics with non-small cell lung cancer. Cox proportional hazard models estimate the hazard of mortality by race with adjustment for individual covariates (age, gender, marital status), clinical factors (histologic grade, surgery, radiation, and chemotherapy), and social and neighborhood factors (neighborhood and ethnic enclave status). Results: A total of 4,062 Hispanic patients with non small cell lung cancer were included. Overall, there was a 7% decreased risk of disease-specific mortality for foreign-born patients as compared with US-born patients (HR 0.93, p=0.08, 95% CI 0.87-1.00) although not-statistically significant. Adjustment for individual patient factors and clinical factors conferred a statistically significant 16% decreased risk of disease-specific mortality compared with US-born patients (HR 0.84, p<0.0001, 95% CI 0.78-0.91). Adjustment for socioeconomic status and neighborhood socioeconomic and ethnic enclave status did not explain the differences in survival (HR 0.84, p <0.001, 95% CI 0.78-0.91). Conclusions: Overall, foreign-born Hispanics with non-small cell lung cancer have a decreased risk of disease-specific mortality compared with US-born Hispanics with non-small cell lung cancer but social factors do not explain this survival advantage. Further investigation is needed to understand the drivers of the survival advantage outcomes in foreign-born populations.