TY - JOUR
T1 - Hispanic and immigrant paradoxes in U.S. Breast cancer mortality
T2 - Impact of neighborhood poverty and hispanic density
AU - Pruitt, Sandi L.
AU - Tiro, Jasmin A.
AU - Xuan, Lei
AU - Lee, Simon J Craddock
N1 - Funding Information:
The authors thank Jan Eberth for the measure of mammography capacity. This work was supported by the Cancer Prevention Research Institute of Texas (CPRIT R1208), the Agency for Healthcare Research and Quality, AHRQ, (R24 HS 22418-01), and the National Center for Advancing Translational Sciences, NCATS, UT Southwestern Center for Translational Medicine (U54 RFA-TR-12-006). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of funding agencies. Cancer data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 211 E. 7th Street, Suite 325, Austin, TX 78701, http://www.dshs.state.tx.us/tcr/default.shtm, or (512) 305-8506.
Publisher Copyright:
© 2016 by the authors; licensee MDPI, Basel, Switzerland.
PY - 2016/12/14
Y1 - 2016/12/14
N2 - 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.
AB - 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.
KW - Breast cancer
KW - Disparities
KW - Ethnic enclave
KW - Hispanic
KW - Immigration
KW - Inequality
KW - Neighborhoods
KW - Poverty
KW - Survival
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U2 - 10.3390/ijerph13121238
DO - 10.3390/ijerph13121238
M3 - Article
C2 - 27983668
AN - SCOPUS:85007143700
SN - 1661-7827
VL - 13
JO - International journal of environmental research and public health
JF - International journal of environmental research and public health
IS - 12
M1 - 1238
ER -