TY - JOUR
T1 - Nativity, ethnic enclave residence, and breast cancer survival among Latinas
T2 - Variations between California and Texas
AU - Shariff-Marco, Salma
AU - Gomez, Scarlett Lin
AU - Canchola, Alison J.
AU - Fullington, Hannah
AU - Hughes, Amy E.
AU - Zhu, Hong
AU - Pruitt, Sandi L.
N1 - Publisher Copyright:
© 2020 American Cancer Society
PY - 2020/6/15
Y1 - 2020/6/15
N2 - 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.
AB - 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.
KW - Latino
KW - breast cancer survival
KW - ethnic enclave
KW - nativity
KW - neighborhood socioeconomic status
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U2 - 10.1002/cncr.32845
DO - 10.1002/cncr.32845
M3 - Article
C2 - 32181892
AN - SCOPUS:85081718669
SN - 0008-543X
VL - 126
SP - 2849
EP - 2858
JO - Cancer
JF - Cancer
IS - 12
ER -