Abstract
BackgroundIn 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.MethodsWe 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.ResultsCompared 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.ConclusionIdentifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.
Highlights
In the United States (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
Lower neighborhood socioeconomic status (SES) was associated with poorer survival, with Hispanic women in the lowest SES neighborhoods 31% more likely to die from
California Health Interview Survey (CHIS) population data (Table 4) indicated that USborn Hispanics were more likely than foreign-born Hispanics to have graduated from high school and college, to speak English well, to have a body mass index below 25 kg/m2, and to have been physically active in the past 30 days. They were more likely to have undergone mammographic screening, had the same health insurance for the past year, remained in the US for medical or dental care, and had someone available to help with daily chores when sick. In this population-based study of Hispanic women diagnosed in California with breast cancer, we found that foreign-born Hispanics were more likely to be diagnosed at an advanced stage of disease than US-born Hispanics, they had better survival, even after consideration of stage at diagnosis, initial treatment, demographic, other tumor characteristics and neighborhood factors, including SES and ethnic enclave
Summary
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. For United States (US) Hispanic ( known as Latina) women, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death [1] Within this population group, breast cancer patterns differ by nativity. To understand the mortality differences between US and foreign-born Hispanics, the aims of this study were to document the breast survival patterns among Hispanics by nativity, and explore whether survival patterns were influenced by neighborhood factors, using population-based cancer registry data enhanced with complete nativity data and linked to residential data on census block-group level SES and ethnic enclave. Understanding the neighborhood influences on outcomes, by nativity, could help identify subgroups at risk of poor outcomes as well as factors that contribute to the observed health advantage in Hispanic immigrants
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