Hispanic Enclave Research Articles

Abstract B093: Residence within Hispanic ethnic enclaves is associated with later stage breast cancer diagnosis among Hispanic women in four U.S. states

Abstract Background/Objective: Many Hispanic or Latino/a individuals (hereafter Hispanic) reside in ethnic enclaves. Hispanic enclaves are places characterized by high prevalence of Hispanic individuals, immigrants, individuals who speak Spanish, and/or ethnic-specific businesses. This population-based study of Hispanic women with breast cancer examines how residence in Hispanic enclaves is associated with late stage diagnosis. Methods: We used data from population-based cancer registries in four states (CA, NJ, NY, TX) to identify Hispanic women with breast cancer diagnosed between 2000-2017. Hispanic enclaves were defined using principal components analysis of four census tract-level variables: percent Hispanic, percent foreign-born Hispanic residents, percent with limited English and percent linguistically isolated and speaking Spanish. All census tracts in the four states were classified into quintiles of ethnic enclave score (pooled across all four states). Using log binomial regression with clustering by census tract, we examined associations of enclave residence (in quintiles) on late stage (regional or distant) compared to early stage (in-situ or localized) diagnosis; we fit unadjusted and adjusted models with age, year of diagnosis, insurance type, state, metropolitan/non-metropolitan census tract residence, and census tract percent poverty as covariates. Results: Among 165,226 Hispanic women, 35.1% were diagnosed at late stage. Two-thirds of women resided in census tracts with the highest ethnic enclave scores: 25.3% in Q4 and 43.6% in Q5. The percent late stage varied by ethnic enclave quintile (29.5% in Q1 to 37.9% in Q5; Chi-square across all quintiles p<0.01. Residence in the highest (Q5) compared to lowest (Q1) enclave quintile was associated with increased risk of late-stage diagnosis in the unadjusted model (RR=1.28 95% CI: 1.24-1.33) and in the fully adjusted model (RR=1.11; 95% CI: 1.07-1.15). Conclusions: Enhanced understanding of the features of ethnic enclaves that may contribute to later stage at breast cancer diagnosis among Hispanic women is important to inform future outreach and intervention. Additional analyses will assess potential for moderation by poverty and will examine whether results vary by enclave characteristics such as the predominant ethnic group (e.g., Mexican, Puerto Rican) or enclave transitions between 2000-2010 (never, former, persistent, emerging enclave). Citation Format: Sandi L. Pruitt, Aniruddha B. Rathod, Kathryn L. Shahan, Alison J. Canchola, Francis P. Boscoe, Kevin A. Henry, Robert A. Hiatt, Amy E. Hughes, Katherine Lin, Dan Meltzer, Paulo S. Pinheiro, Antoinette M. Stroup, Hong Zhu, Scarlett L. Gomez, Salma Shariff-Marco. Residence within Hispanic ethnic enclaves is associated with later stage breast cancer diagnosis among Hispanic women in four U.S. states [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B093.

Mixed Embeddedness and Hispanic Entrepreneurship: Role of Hispanic Enclaves and Acculturation

Mixed Embeddedness and Hispanic Entrepreneurship: Role of Hispanic Enclaves and Acculturation

Ethnic enclaves and colon cancer stage at diagnosis among New Jersey Hispanics

Ethnic enclaves are neighborhoods with high concentrations of individuals of the same ethnic origin. Researchers have hypothesized that residence in ethnic enclaves may contribute to cancer outcomes through detrimental or protective pathways. A limitation of previous work, however, is their cross-sectional approach whereby an individual's residence at the time of diagnosis was used to capture residence in an ethnic enclave at a single point in time. This study addresses this limitation by adopting a longitudinal approach to investigating the association between the duration of residence in an ethnic enclave and the colon cancer (CC) stage at diagnosis. Colon cancer incidence cases diagnosed between 2006 and 2014, for Hispanics aged 18 years and older from the New Jersey State Cancer Registry (NJSCR) were linked to residential histories obtained from a commercial database LexisNexis, Inc. We examined associations between residence in an enclave and stage at diagnosis using binary and multinomial logistic regression, adjusted for age, sex, primary payer, and marital status. Among the 1076 Hispanics diagnosed with invasive colon cancer in New Jersey from 2006 to 2014, 48.4% lived in a Hispanic enclave at the time of diagnosis. Over the ten years preceding CC diagnosis, 32.6% lived in an enclave for the entire period. We found that Hispanics living in an ethnic enclave at diagnosis had significantly lower odds of distant-stage CC than Hispanics not living in an enclave at the time of diagnosis. Additionally, we found a significant association between living in an enclave for an extended period (e.g., over ten years) and lower odds of being diagnosed with distant stage CC. Integrating residential histories opens research possibilities to examine how minorities' residential mobility and residence in enclaves affect cancer diagnosis over time.

Abstract 3671: Association between residence in a Hispanic enclave and end-induction minimal residual disease among children with acute lymphoblastic leukemia in Texas

Abstract Background: Acute lymphoblastic leukemia (ALL) remains a leading cause of death in children and adolescents. We have demonstrated that Hispanic enclaves - neighborhoods with high proportions of Spanish-speaking residents, recent immigrants, and ethnic-specific businesses - are associated with inferior overall survival in children with ALL. However, associations of enclaves with other outcomes remain poorly understood. In the present study, our objective was to determine whether residence in an enclave was associated with end-induction minimal residual disease (MRD), a strong predictor of ALL mortality. Methods: This was a retrospective study of N=142 children aged 0-18 years, treated at Texas Children’s Hospital (Houston, TX) from 2007-2018. MRD was defined as ≥0.01% leukemic blasts in bone marrow at day 29 of therapy. We used the 2010 census tract geography and a modified version of the Hispanic enclave index to identify enclaves. We assigned an enclave index score to each census tract, computed quartiles based on the statewide distribution, and mapped children to quartiles based on address at diagnosis (Q1: least ethnically distinct neighborhoods; Q4: most ethnically distinct neighborhoods). Data on sex, self-reported race/ethnicity, National Cancer Institute (NCI) risk group, primary language, and ALL cytogenetics were abstracted from electronic health records. Cytogenetics were considered either unfavorable (BCR-ABL1 fusion, KMT2A rearrangement, hypodiploidy, or intrachromosomal amplification of chromosome 21) or favorable (ETV6-RUNX1 fusion, double trisomies of chromosomes 4 and 10)/neutral (neither favorable nor unfavorable). We estimated the odds ratio (OR) and 95% confidence interval (95% CI) of MRD according to enclave index score using logistic regression. Results: Neither individual ethnicity nor primary language varied by MRD status, but a greater proportion of MRD-positive children lived in the most ethnically distinct neighborhoods (53% vs. 36%, p=0.04). Enclave index score was associated with MRD after adjusting for sex, NCI risk group, and cytogenetics (OR 1.57 per quartile increment, 95% CI 1.09-2.33). We also observed non-significantly increased odds of MRD among children in Q3 (OR 1.53, 95% CI 0.41-6.55) and Q4 (OR 2.84, 0.83-11.58) relative to Q1. Conclusions: We found that residence in a Hispanic enclave was associated with MRD in children with ALL. Neither ethnicity nor primary language differed by MRD status, suggesting that these did not confound the association with enclave index score. Neighborhood factors may influence early treatment outcomes in ALL, and children living in Hispanic enclaves may constitute a high-risk population. Citation Format: Joshua P. Muniz, John P. Woodhouse, Amy E. Hughes, Sandi L. Pruitt, Karen R. Rabin, Michael E. Scheurer, Philip J. Lupo, Jeremy M. Schraw. Association between residence in a Hispanic enclave and end-induction minimal residual disease among children with acute lymphoblastic leukemia in Texas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3671.

Asian American/Pacific Islander and Hispanic Ethnic Enclaves, Neighborhood Socioeconomic Status, and Hepatocellular Carcinoma Incidence in California: An Update.

Using more recent cancer registry data, we analyzed disparities in hepatocellular carcinoma (HCC) incidence by ethnic enclave and neighborhood socioeconomic status (nSES) among Asian American/Pacific Islander (AAPI) and Hispanic populations in California. Primary, invasive HCC cases were identified from the California Cancer Registry during 1988-1992, 1998-2002, and 2008-2012. Age-adjusted incidence rates (per 100,000 population), incidence rate ratios, and corresponding 95% confidence intervals were calculated for AAPI or Hispanic enclave, nSES, and the joint effects of ethnic enclave and nSES by time period (and the combination of the three periods), sex, and race/ethnicity. In the combined time period, HCC risk increased 25% for highest versus lowest quintile of AAPI enclave among AAPI males. HCC risk increased 22% and 56% for lowest versus highest quintile of nSES among AAPI females and males, respectively. In joint analysis, AAPI males living in low nSES areas irrespective of enclave status were at 17% to 43% increased HCC risk compared with AAPI males living in areas of nonenclave/high nSES. HCC risk increased by 22% for Hispanic females living in areas of low nSES irrespective of enclave status and by 19% for Hispanic males living in areas of nonenclave/low nSES compared with their counterparts living in areas of nonenclave/high nSES. We found significant variation in HCC incidence by ethnic enclave and nSES among AAPI and Hispanic populations in California by sex and time period. Future studies should explore how specific attributes of enclaves and nSES impact HCC risk for AAPI and Hispanic populations.

Nativity Status is an Important Social Determinant of Health for Hispanic Patients with Gastric Cancer in Texas.

The U.S. foreign-born population is rapidly increasing, and cancer incidence/mortality rates have been shown to differ by nativity status. Our study aimed to characterize differences in gastric cancer presentation and survival among Hispanic patients in Texas by nativity status. We conducted a retrospective review of the Texas Cancer Registry to identify Hispanic patients diagnosed with gastric adenocarcinoma between 2004 and 2017. Existing indices applied to 2010 census tract-level data were utilized to measure neighborhood socioeconomic status (nSES) and Hispanic enclaves. Nativity status was imputed for patients with missing data. Multivariable Cox proportional hazard models were fit for overall survival adjusted for age, insurance status, diagnosis year, tumor location, stage, grade, reporting source, nativity status, nSES, and Hispanic enclave. Our study cohort consisted of 6186 patients and 39% were foreign-born. A greater proportion of foreign-born patients were diagnosed at < 45years old (16% vs. 11%, p < 0.0001) and had metastatic disease at presentation (47% vs. 34%, p < 0.0001). Foreign-born patients were more often uninsured, in the lowest nSES quintile, and the highest (most ethnically distinct) quintile for Hispanic enclave. Stage-specific overall survival was significantly higher among foreign-born patients. In our multivariate model, foreign-born Hispanic patients had improved survival versus US-born (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82-0.99). The clinical presentation of gastric cancer differs significantly between foreign-born and U.S.-born Hispanic patients. Foreign-born Hispanic patients have improved survival after adjusting for socioeconomic, neighborhood, and clinical factors. Further studies are needed to identify specific causal mechanisms driving the observed survival difference by nativity status.

Residence in a Hispanic Enclave Is Associated with Inferior Overall Survival among Children with Acute Lymphoblastic Leukemia.

Hispanic children with acute lymphoblastic leukemia (ALL) experience poorer overall survival (OS) than non-Hispanic White children; however, few studies have investigated the social determinants of this disparity. In Texas, many Hispanic individuals reside in ethnic enclaves—areas with high concentrations of immigrants, ethnic-specific businesses, and language isolation, which are often socioeconomically deprived. We determined whether enclave residence was associated with ALL survival, overall and among Hispanic children. We computed Hispanic enclave index scores for Texas census tracts, and classified children (N = 4083) as residing in enclaves if their residential tracts scored in the highest statewide quintile. We used Cox regression to evaluate the association between enclave residence and OS. Five-year OS was 78.6% for children in enclaves, and 77.8% for Hispanic children in enclaves, both significantly lower (p < 0.05) than the 85.8% observed among children not in enclaves. Children in enclaves had increased risk of death (hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.01–1.49) after adjustment for sex, age at diagnosis, year of diagnosis, metropolitan residence and neighborhood socioeconomic deprivation and after further adjustment for child race/ethnicity (HR 1.19, 95% CI 0.97–1.45). We observed increased risk of death when analyses were restricted to Hispanic children specifically (HR 1.30, 95% CI 1.03–1.65). Observations suggest that children with ALL residing in Hispanic enclaves experience inferior OS.

Colon cancer care of Hispanic people in California: Paradoxical barrio protections seem greatest among vulnerable populations.

Background: We examined paradoxical and barrio advantaging effects on cancer care among socioeconomically vulnerable Hispanic people in California.Methods: We secondarily analyzed a colon cancer cohort of 3,877 non-Hispanic white (NHW) and 735 Hispanic people treated between 1995 and 2005. A third of the cohort was selected from high poverty neighborhoods. Hispanic enclaves and Mexican American (MA) barrios were neighborhoods where 40% or more of the residents were Hispanic or MA. Key analyses were restricted to high poverty neighborhoods.Results: Hispanic people were more likely to receive chemotherapy (RR=1.18), especially men in Hispanic enclaves (RR=1.33) who were also advantaged on survival (RR=1.20). A survival advantage was also suggested among MA men who resided in barrios (RR=1.80).Conclusions: The findings were supportive of Hispanic paradox and MA barrio advantage theories. They further suggested that such advantages are greater for men, perhaps due to their greater spousal and extended familial support.Significance for public healthHispanic Americans are three-times as likely to live in poverty as non-Hispanic white Americans. Despite this, Hispanic enclaves, Mexican American barrios, in particular, seem to be relatively protective. Considering cancer care in California, for example, Hispanic men who live in such Hispanic enclaves/barrios are particularly advantaged in their access to cancer care and survival. Such communities may effectively double the protective effects of familialism that many Hispanic men already enjoy through marriage.

Abstract C064: Neighborhood socioeconomic status, ethnic enclave, and hepatocellular carcinoma incidence in Hispanics and Asians/Pacific Islanders living in California: An update

Abstract Background: Disparities in hepatocellular carcinoma (HCC) incidence exist by sex and race/ethnicity, with rates higher in men than women and higher in Asians/Pacific Islanders (API) and Hispanics than non-Hispanic Whites. We sought to update previous studies that identified disparities in HCC incidence by neighborhood contextual factors such as SES and ethnic enclave among API and Hispanic populations in California by analyzing data from the California Cancer Registry (CCR) through 2012. Methods: All primary, invasive HCC cases diagnosed from 1988 through 2012 from the CCR were identified and their addresses geocoded. Neighborhood Hispanic or API ethnic enclaves are areas marked by greater immigrant composition and linguistic isolation, applicable to Hispanic and API residents, respectively. Neighborhood SES (nSES) is an index measure comprising data on education, occupation, and housing. Age-adjusted incidence rates (IRs; per 100,000 population; standardized to the 2000 U.S. standard million population), incidence rate ratios (IRRs) (with corresponding 95% confidence intervals (CI)) were calculated for each strata of nSES and ethnic enclave by sex and race/ethnicity. Results: The final analysis included 9,636 males (4,883 Hispanics, 4,753 APIs) and 3,524 females (1,744 Hispanics, 1,780 APIs). During 1988-2012, among Hispanics, there were no clear associations between HCC incidence and nSES or ethnic enclave when considered separately. However, compared to those in high nSES/low enclave neighborhoods, Hispanic males living in low nSES/low enclave neighborhoods and Hispanic females living in low SES/high enclave neighborhoods had higher incidence of HCC (males: IRR = 1.22, CI = 1.10 - 1.36; females: IRR = 1.20, CI = 1.04 - 1.38). Among APIs, there was no association between HCC incidence and ethnic enclave but there was a strong association of increased risk for those living in the lowest vs. highest nSES neighborhoods (males: IRR = 1.69, CI = 1.53 - 1.87; females: IRR = 1.32, CI = 1.12 - 1.56). API males living in low nSES/high enclave neighborhoods had higher incidence of HCC than those living in high nSES/low enclave neighborhoods (IRR = 1.36, CI = 1.22 - 1.52). Conclusions: We found significant variation in HCC incidence by two important neighborhood factors, nSES and ethnic enclave, among Hispanics and APIs living in California, with similar findings to previous studies. Future studies with longitudinal data are needed to explore which attributes of nSES and enclaves are impacting HCC risk and for which subpopulations (such as recent immigrants). Citation Format: Meera Sangaramoorthy, Alice Guan, Juan Yang, Jennfier Jain, Mindy C. DeRouen, Scarlett Lin Gomez, Salma Shariff-Marco. Neighborhood socioeconomic status, ethnic enclave, and hepatocellular carcinoma incidence in Hispanics and Asians/Pacific Islanders living in California: An update [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C064.

Abstract C065: Multilevel factors associated with depressive symptoms among long-term survivors of childhood cancer

Abstract Introduction Previous research has identified individual-level clinical and demographic factors associated with the mental health of childhood cancer survivors (CCS), but cultural and contextual factors have not been as thoroughly explored. Additionally, Hispanics are underrepresented in studies of CCS, so improved understanding of unique correlates of mental health among this population is needed. Methods Depressive symptoms were assessed among a sample of 1,106 young adult CCS. Participants were selected from the Los Angeles County SEER Cancer Registry, and were diagnosed at ages 0-19 between 1996-2010 with any cancer, at least 5 years post diagnosis, treated 2+ years ago, currently aged 18-39. Analyses were restricted to Hispanic participants currently living in California (n=522) who completed an acculturation measure. Multivariable linear regression was used to assess the association of depressive symptoms with neighborhood Hispanic ethnic enclave and individual acculturation, controlling for relevant demographic and clinical factors. Ethnic enclave residence was also explored as a potential moderator of the effect of acculturation on depressive symptoms. Ethnic enclave is a composite index based on census data reflecting household linguistic isolation, English language proficiency, and proportion of Hispanics, foreign born, and recent immigrants in a given census tract. This index score was dichotomized for analysis (based on the statewide distribution). A bi-dimensional acculturation scale measured Hispanic and Anglo orientation, but due to limited variability on the Anglo subscale (majority of the sample reported high Anglo orientation), it was excluded from the interaction model to focus on differences by Hispanic orientation. Results In a multivariable model of main effects controlling for age, sex, treatment intensity, years since diagnosis, and education, a significant negative association between Hispanic orientation and depressive symptoms was found (b=-0.17, p=0.03) while no significant association was found for ethnic enclave. When accounting for the interaction, ethnic enclave was found to moderate the association with Hispanic orientation. When stratifying models by enclave, Hispanic orientation was negatively associated with depressive symptoms for those residing in high ethnic enclaves (b=-0.24, p=0.01), while there was no significant association observed for those residing in low enclaves. Conclusions These results suggest that concordance between an individual’s ethnic orientation and the neighborhood cultural context may be protective against poor mental health. One potential mediating factor is increased social support and future research should examine this factor to better understand contributors to mental health across the survivorship continuum among CCS and to identify groups that may benefit from targeted intervention and/or survivorship support services. Citation Format: Jessica Tobin, Myles Cockburn, Brian K Finch, Ann S Hamilton, Joel E Milam. Multilevel factors associated with depressive symptoms among long-term survivors of childhood cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C065.

Did Immigrant Incorporation Overcome Structural Discrimination in Federal Place-based Antipoverty Implementation?

ABSTRACT Most antipoverty programs target people. In the 1990s, the Federal government launched place-based initiatives to direct resources to places with high poverty to address decades of structural discrimination and segregation. Immigrant incorporation theory suggests that local receptivity varies depending on if places are homogenous, bifurcated (i.e., two racialized or ethnic populations), or multiethnic. Multivariate analysis of annual reports (n = 127) from 1996– 2008 and Census population data find that Hispanic enclaves, bifurcated Hispanic places (as opposed to multiracial), and those with increasing immigrant populations are more likely to have immigrant-friendly projects. Implications for policy and practice are discussed.

Characterizing Micro-scale Disparities in Childhood Obesity: Examining the Influence of Multilevel Factors on 4-Year Changes in BMI, Healthy Eating, and Physical Activity, Among a Cohort of Children Residing in Disadvantaged Urban Enclaves.

The childhood obesity epidemic in the United States disproportionately affects minority, low-income populations. Hispanics have one of the highest childhood obesity rates, and are the fastest growing population subgroup in the country. Past research has examined disparities in the occurrence of obesity, healthy eating, and physical activity at a macro-geographic level, with less emphasis on examining the multilevel, micro-scale determinants of childhood obesity in disadvantaged urban ethnic enclaves. The aim of our study was to identify child-, parental-, familial-, community-, and neighborhood-level factors associated with differences in 4-year changes in BMI, healthy eating, and physical activity, among children residing in low-income, predominantly Hispanic urban enclaves in Austin, Texas. This analysis used data from the Go Austin! Vamos Austin! (GAVA) Evaluation study, a cohort with 4 years of follow-up from 313 child-caregiver dyads. The dependent variables were change categories denoting 4-year increase, decrease, or no change in Body Mass Index (BMI) percentile, fruit and vegetable intake, and physical activity, among child participants. The independent variables were factors at multiple levels of the socio-ecological model: child, parental, familial, community, and environmental. Multinomial logistic regression models were used to estimate the odds of children being in the “increasing” or “decreasing” categories for the three dependent variables (vs. “no change”), in association with the studied independent variables. The results showed that among children residing in this low-income, predominantly Hispanic urban enclave, weight gain prevention and weight loss have different determinants. We identified relevant micro-scale disparities, and micro-level factors of influence on child BMI and its related health behaviors, at all levels of the socio-ecological model. Our results revealed evidence, through the characterization of positive deviance cases (children for whom decreases in BMI, increases in fruit and vegetable intake, or increases in physical activity were observed) which could potentially help mitigate established unhealthy habits among high need populations. Factors associated with positive deviance for BMI (decreases in child BMI) included male child sex (OR: 0.33, 95% CI: 0.12–0.83) and living in a food-insecure household (OR: 0.24, 95% CI: 0.13–0.79). Our findings may inform the design of obesity prevention interventions in these types of disadvantaged urban Hispanic enclaves.

Multiplicative Advantages of Hispanic Men Living in Hispanic Enclaves: Intersectionality in Colon Cancer Care

Multiplicative Advantages of Hispanic Men Living in Hispanic Enclaves: Intersectionality in Colon Cancer Care

Abstract 3434: Neighborhood obesogenic environment and the risk of prostate cancer: The Multiethnic Cohort

Abstract Background: Obesity is a potentially modifiable risk factor for advanced prostate cancer (PCa). However, the role of the neighborhood obesogenic environment, characterized by obesity-related built and social environment measures, has not been evaluated in relation to PCa risk. Objective: To examine the association of neighborhood obesogenic environment with PCa risk in African American (AA), Japanese American (JA), Latino (LA), and White (WH) men in the California component of the Multiethnic Cohort (MEC) Study. Method: Individual-level sociodemographic data and health behaviors were linked with neighborhood measures of built and social environment for 42,850 men in the MEC, who predominately live in Los Angeles County. A principal components factor analysis was used to create indices based on 10 measures—neighborhood SES, population density, total businesses, recreational facilities, retail food environment, restaurant environment, parks, street connectivity, commuting by car, and traffic density—resulting in 4 obesogenic environment indices: physically active, low SES urban, businesses density, and unhealthy food. During a mean follow-up of 15 years and through linkage to the California Cancer Registry, 4,775 incident PCa cases were identified. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between each index and PCa risk, overall and stratified by race/ethnicity and disease aggressiveness. For Latinos, additional stratified analyses were conducted by nativity. Results: Associations between the obesogenic indices and PCa risk varied by race/ethnicity. WH residing in low business environments experienced lower PCa risk (quintile [Q] 1 [low] vs. Q5 [high]: HR, 0.56 [95% CI, 0.41-0.77], p-trend: 0.0002). Among AA, unhealthy food environments were associated with greater risk of aggressive disease (advance stage or Gleason score &amp;gt; = 7) (more vs. no: HR, 1.36 [95% CI, 1.09-1.70], p-trend: 0.0026). Among LA, living in Hispanic enclaves was associated with reduced risk (Q3-5 [high] vs. Q1-2 [low]: HR, 0.86 [95% CI, 0.75-0.98]), but living in high business environments was associated with increased risk of PCa (Q1 [low] vs. Q5 [high]: HR, 1.35 [95% CI, 1.05-1.73], p-trend: 0.0002) for those born in the US (p-trend: 0.0059). Lower SES urban environments were associated with a decreased risk of non-aggressive disease among LA (Q5 [low] vs. Q1 [high]: HR, 0.78 [95% CI, 0.63-0.98], p-trend: 0.0026), and was more marked among foreign-born (p trend = 0.0074) than US-born (p trend = 0.1211). Conclusions: Built and social environment factors are associated with PCa risk, but their associations varied by race/ethnicity, nativity (among LA), and disease aggressiveness. An unhealthy food environment was strongly associated with the risk of aggressive prostate cancer in AA men, warranting further investigation into the underlying mechanisms. Citation Format: Li Tao, Scarlett L. Gomez, Salma Shariff-Marco, Juan Yang, Song Yi Park, Cheryl Albright, Kristine Monroe, Brian Henderson, Laurence Kolonel, Loic Le Marchand, Lynne Wilkens, Iona Cheng. Neighborhood obesogenic environment and the risk of prostate cancer: The Multiethnic Cohort. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3434.

Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients.

The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate density, there was an increase in depressive symptoms, but depressive symptoms slightly declined in census tracts with the highest density of Hispanics. Furthermore, gender significantly moderated the relation between Hispanic ethnic density and 1-year depressive symptom severity, such that Hispanic ethnic density was significantly associated with increased depressive symptom severity for female Hispanic patients with ACS, but not for male Hispanic patients. Previous research suggests that ethnic density may be protective against depression in Hispanic enclaves; however, our findings suggest a non-linear ethnic density effect and an overall more complex association between ethnic density and depression. These data add to a growing body of literature on the effects of sociodemographic and contextual factors on health.

Nativity and neighborhood characteristics and cervical cancer stage at diagnosis and survival outcomes among Hispanic women in California.

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. 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. 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. Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.

Abstract A73: Breast cancer subtype distribution and survival among Hispanic women in California

Abstract Background: Evidence on the burden of breast cancer subtypes among Hispanic women is limited, as prior research suggests that Hispanics may be prone to develop those subtypes that are associated with poor prognosis. Additionally, few studies have characterized the population-based distribution of breast cancer subtypes among Hispanic women, by the joint expression of hormone receptors (HR: estrogen receptor (ER) and/or progesterone receptor (PR)), and human epidermal growth factor receptor 2 (HER2). Purpose: Our objective was to assess the distribution and survival of breast cancer subtypes among Hispanic women diagnosed with primary, invasive breast cancer between 2005 and 2010 in California. Methods: Based on information from the California Cancer Registry, breast cancer subtypes were defined as: HR positive/HER2 negative (HR+/HER2-); HR+/HER2+; HR-/HER2+; and triple negative (HR-/HER2-). We calculated frequency distributions of breast cancer subtypes and used polytomous multivariate logistic regression to evaluate their associations with clinical and demographic factors, including socioeconomic status (SES) and Hispanic enclave (based on quintile distribution across the state of California), and nativity. Kaplan-Meier and Cox proportional hazards regression methods were used to assess breast cancer-specific survival and mortality. Results: Among 16,380 Hispanic breast cancer patients, HR+/HER- was the predominant subtype (62.6%), followed by triple negative (15.6%), HR+/HER2+ (13.8%) and HR-/HER2+ (8.1%). Women living in lower SES neighborhoods had a greater risk of triple negative (p&amp;lt;0.01) and HR-/HER2+ (p&amp;lt;0.01) subtypes. Hispanic women diagnosed with triple negative and HR-/HER2+ tumors were substantially more likely to die from the disease (HR=5.00, 95% CI:4.19-5.96 and HR=2.74, 95% CI:2.20-3.41, respectively) than patients with the HR+/HER- subtype. Breast cancer-specific mortality increased with decreasing SES, from HR=1.37 (95% CI:0.97-1.93) for quintile 4 to HR=1.77 (95% CI:1.25-2.51) for quintile 1 (lowest neighborhood SES level). Conclusion: In the most comprehensive analysis of breast cancer subtypes among Hispanic women in the United States to date, our findings indicate that low SES was significantly associated with increased risk of developing and dying from breast cancer subtypes with poor prognosis. Foreign-born women were at greater risk than US-born of HR-/HER2+ tumors, although nativity was not associated with other subtypes. Hispanic women diagnosed with HR- breast cancer subtypes were at significantly increased risk of death; especially, those with triple negative breast cancer. While these results indicate that the distribution and burden of breast cancer subtypes among California Hispanic women are similar to other racial/ethnic populations, it is imperative to better understand the impact of SES on risk factor exposures that increase the risk of developing specific breast cancer subtypes. Citation Format: Matthew P. Banegas, Li Tao, Sean Altekruse, William F. Anderson, Esther M. John, Christina A. Clarke, Scarlett L. Gomez. Breast cancer subtype distribution and survival among Hispanic women in California. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A73. doi:10.1158/1538-7755.DISP13-A73

Occupational segregation of Hispanics in US metropolitan areas

This article quantifies the occupational segregation of Hispanics in the largest Hispanic enclaves of the US. Using a procedure based on propensity score, it explores the role played by the characteristics of Hispanics, such as country of origin and English fluency, in explaining the variation of segregation across metropolitan areas. Regarding the characteristics of the metropolitan areas, a regression analysis shows that the segregation of Hispanic workers tends to be higher in relatively smaller and highly educated labour markets, with a lower proportion of Hispanics, a higher growth of recent foreign-born Hispanics and in areas where they face cooler feelings from the rest of the population.

Gastric cancer incidence among Hispanics in California: patterns by time, nativity, and neighborhood characteristics.

Better understanding about gastric cancer incidence patterns among Hispanics by birthplace, socioeconomic status (SES), and acculturation can improve preventive strategies and disease models. Incidence rates, rate ratios, and estimated annual percent change (EAPC) in rates of anatomic and histologic subtype-specific gastric cancer were calculated by age, sex, and nativity among Hispanics using California Cancer Registry data from 1988 through 2004. Incidence rates in 1998 to 2002 were compared by neighborhood SES and Hispanic enclave status according to 2000 US Census data. Incidence rates of diffuse gastric cancer increased from 1988 through 2004 among foreign-born Hispanic men (EAPC: 3.5%, 95% CI: 1.5%-5.5%) and U.S.-born Hispanic women (EAPC: 3.0%, 95% CI: 0.7%-5.3%). During the same time period, incidence rates of intestinal gastric cancer declined significantly and both cardia and noncardia gastric cancer were steady or declined among foreign-born and U.S.-born Hispanic men and women. Noncardia and both intestinal and diffuse gastric cancer were more common in foreign-born than U.S.-born Hispanic men and women, and in those from lower SES, higher enclave neighborhoods. By contrast, among younger and middle-aged Hispanic men, cardia tumors were more common in the U.S.-born than the foreign-born, and in higher SES, lower enclave neighborhoods. Varying gastric cancer risk factors among Hispanic subgroups and increasing rates of diffuse gastric cancer in foreign-born Hispanic men and U.S.-born Hispanic women merit further investigation to identify separate disease etiologies. Age, sex, birthplace, SES, and acculturation modify gastric cancer incidence in Hispanics and should be considered when examining disease risk and prevention.

The influence of nativity and neighborhoods on breast cancer stage at diagnosis and survival among California Hispanic women

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.