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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Cancer 1/2017

High cancer mortality for US-born Latinos: evidence from California and Texas

Zeitschrift:
BMC Cancer > Ausgabe 1/2017
Autoren:
Paulo S. Pinheiro, Karen E. Callahan, Scarlett Lin Gomez, Rafael Marcos-Gragera, Taylor R. Cobb, Aina Roca-Barcelo, Amelie G. Ramirez
Abbreviations
CA
California
CI
Confidence intervals
CRC
Colorectal cancer
CUP
Cancers of unknown primary
HBV
Hepatitis B virus
HCV
Hepatitis C virus
HPV
Human papillomavirus
NHL
Non-Hodgkin lymphoma
NLB
Non-Latino black
NLW
Non-Latino white
NYC
New York City
SEER
Surveillance, Epidemiology and End Results
TX
Texas
US
United States

Background

Cancer accounts for 22% of all deaths among Latinos in the United States (US), a population of 55 million [ 1, 2]. Yet, Latinos suffer a lower burden of cancer compared to both non-Latino black (NLB) and non-Latino white (NLW) populations, including lower incidence for almost all cancers except gall bladder and infection-related cancers: cervix, liver and stomach [ 1, 3]. Because overall incidence is lower among Latinos, overall cancer mortality tends to also be lower [ 1, 4]. These observed advantages may be partially due to the Healthy Immigrant Effect, whereby low incidence and mortality are the result of a steady immigrant influx of lower-risk populations [ 5, 6].
Acculturation, the complex process by which members of a foreign-born minority population adapt to traits from a prevailing majority [ 7], has been shown to change several important risk factors for cancer [ 8, 9], including increased prevalence of tobacco smoking, obesity, metabolic syndrome, diabetes, and hepatitis C virus infection with longer time spent in the US [ 9]. Consequently, the more acculturated US-born Latinos may be at higher risk for cancer.
Several studies that examined overall cancer mortality by birthplace found higher rates for US-born populations compared to their foreign-born counterparts [ 1013]. Thus, aggregating cancer rates for any US minority population with significant immigrant proportions, whether Latino, Asian, or Black, may obscure important differences. Moreover, for the whole US, or within each state, the relative weight of the foreign-born population in each racial or ethnic group modifies that group’s observed cancer patterns. For example, while the foreign-born proportion of Blacks in the US is low overall, states such as Florida and New York, with relatively high proportions of Black Caribbean immigrants, have lower cancer mortality among Blacks than the US average [ 13].
For Latinos, detailed mortality analyses by cancer site according to birthplace are not available. We address this data gap and examine cancer mortality data from California (CA) and Texas (TX), the two states with the largest Latino populations in the US, 14 and 9.5 million respectively, comprising 47% of all US Latinos in 2010 [ 2]. By comparing cancer mortality in Latinos stratified by birthplace with NLWs and NLBs, we aim to provide a detailed description of cancer outcomes, particularly highlighting differences between two distinct Latino populations: those 36 million (65%) that are US-born, and the 19 million (35%) that are foreign-born [ 14]. This information will be valuable to health policy makers tasked with reducing disparities and monitoring the health outcomes of this burgeoning US minority population.

Methods

Mortality data for 5 years, January 1, 2008 through December 31, 2012, were obtained from the California Department of Health Center for Health Statistics and Informatics and the Texas Department of State Health Services. Among the resident cases in each state, we analyzed 20 common causes of cancer deaths as well as all-sites-combined cancer which included all cases of malignant cancers. Cancer site was coded according to the International Statistical Classification of Diseases 10th revision. Ethnicity text fields and birthplace were examined in detail to obtain accurate race/ethnicity group information for each decedent, thereby minimizing misclassification. Population denominators for the states of California and Texas were obtained from the 5-year American Community Survey (2008–2012) [ 15].
Cancer mortality rates for 2008–2012 were calculated per 100,000 persons, by sex, annualized and age-standardized to the 2000 US Standard Population using 18 age group bands, all 5-year except the last, 85 and older. Corresponding 95% confidence intervals (CIs) for mortality rates were calculated with gamma intervals modification. To directly compare rates between Latinos in aggregate, US-born Latinos, foreign-born Latinos and the referent NLW population, we computed age-adjusted site-specific mortality rate ratios using negative binomial regression. Models included decedents ages 40 and over.
SAS 9.3 was used for data analysis. This study was approved by the University of Nevada, Las Vegas Institutional Review Board. Data use agreements were obtained from each state.

Results

Cancer was the cause of death for 282,733 Californians and 183,018 Texans in 2008–2012. Among these, 44,283 (16%) in California and 33,073 (18%) in Texas were of Latino ethnicity. Of these Latino decedents, 43% in California and 33% in Texas were born outside of the 50 US states (Table 1).
Table 1
Characteristics of the Study Population by State, 2008–2012
 
Population Data (Census 2010 and American Community Survey)
Cancer Mortality Data (2008–2012)
 
Total Population
Deaths from Cancer
% Cancer/All Deaths
% Foreign-born within racial/ethnic group
CALIFORNIA
 Non-Latino White
14,956,253
185,789
24%
10%
 Non-Latino Black
2,436,082
21,024
23%
3%
 Latino
14,013,719
44,283
23%
57%
  US-Born
8,580,121
18,920
20%
0%
  Foreign-Born
5,433,598
25,363
25%
100%
 Mexican
12,055,090
35,832
22%
53%
 Central American
1,193,268
3845
25%
96%
 South American
309,569
1757
30%
96%
 Caribbean a
305,901
1652
21%
77%
 Other Latino b
149,891
1197
23%
15%
TEXAS
 Non-Latino White
11,397,345
122,899
22%
2%
 Non-Latino Black
3,019,318
22,690
23%
1%
 Latino
9,460,921
33,073
20%
33%
  US-Born
6,458,501
22,034
19%
0%
  Foreign-Born
3,002,420
11,039
25%
100%
a Includes Caribbean Latinos (Dominican Republic, Cuba and Puerto Rico)
b Includes those of Spaniard (European Spanish) origin or birthplace Spain
The leading causes of cancer mortality among Latinos overall were lung, prostate, female breast, colorectal (CRC), liver and pancreatic cancers, with only slight differences between the two states. Among all analyzed groups, foreign-born Latinos had the lowest all-cancers-combined mortality rates and NLBs had the highest. By cancer site, there was considerable heterogeneity: Latino mortality rates were lower than NLWs and NLBs for lung, breast and bladder cancers, among others; however, for stomach and cervical cancers, rates were similar to NLBs, and significantly higher than NLWs. For colorectal cancer, US-born Latino males in both states had high mortality rates, surpassed only by NLBs. In both states, liver and kidney mortality rates for US-born Latinos were the highest of all analyzed populations (Tables 2 and 3).
Table 2
Annual Age-Adjusted a Mortality Rates for Selected Cancers per 100,000, California, 2008–2012
 
All Combined b
Non-Latino White
Non-Latino Black
All Latino
Foreign-born Latino
US-born Latino
 
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
Male
Oral Cavity and Pharynx
3128
3.7
(3.6–3.9)
2088
4.2
(4.0–4.4)
207
4.3
(3.7–4.9)
400
2.5
(2.2–2.7)
217
2.1
(1.8–2.4)
183
3.1
(2.6–3.6)
Esophagus
4935
6.1
(6.0–6.3)
3705
7.6
(7.4–7.9)
207
4.8
(4.1–5.5)
667
4.4
(4.0–4.7)
349
3.5
(3.1–3.9)
318
5.7
(5.1–6.4)
Stomach
4474
5.6
(5.5–5.8)
1876
3.9
(3.8–4.1)
369
8.8
(7.9–9.8)
1316
8.2
(7.7–8.7)
909
8.7
(8.1–9.4)
407
7.3
(6.6–8.1)
Colorectum
13,249
16.8
(16.5–17.1)
8114
17.0
(16.6–17.4)
1115
26.1
(24.5–27.7)
2380
15.5
(14.9–16.2)
1237
12.7
(12.0–13.6)
1143
20.0
(18.8–21.2)
Liver
9076
10.7
(10.4–10.9)
4028
8.0
(7.7–8.2)
685
13.3
(12.3–14.4)
2360
14.0
(13.4–14.6)
1078
10.7
(10.0–11.4)
1282
19.8
(18.6–20.9)
Gallbladder
353
0.4
(0.4–0.5)
169
0.3
(0.3–0.4)
17
0.4
(0.2–0.6)
102
0.7
(0.6–0.9)
57
0.6
(0.5–0.9)
45
0.8
(0.6–1.1)
Pancreas
9483
11.9
(11.7–12.2)
6126
12.6
(12.3–12.9)
696
15.7
(14.4–16.9)
1598
10.7
(10.1–11.2)
929
10.1
(9.4–10.9)
669
11.7
(10.8–12.7)
Lung
34,113
44.3
(43.8–44.8)
23,578
49.5
(48.8–50.1)
2718
63.5
(61.0–66.1)
3586
26.6
(25.7–27.5)
2079
25.2
(24.0–26.4)
1507
29.0
(27.5–30.6)
Melanoma
3148
3.9
(3.8–4.1)
2887
6.1
(5.9–6.3)
22
0.4
(0.3–0.7)
186
1.1
(1.0–1.3)
127
1.3
(1.1–1.6)
59
0.9
(0.7–1.2)
Prostate
15,326
21.4
(21.1–21.8)
10,406
22.3
(21.9–22.7)
1696
48.6
(46.3–51.1)
2212
19.2
(18.4–20.1)
1291
18.3
(17.3–19.4)
921
20.8
(19.4–22.2)
Kidney
4170
5.2
(5.0–5.3)
2639
5.4
(5.2–5.7)
264
5.7
(5.0–6.5)
890
5.6
(5.2–6.0)
453
4.5
(4.1–5.0)
437
7.2
(6.5–8.0)
Bladder
5037
6.9
(6.7–7.1)
4018
8.5
(8.3–8.8)
221
5.8
(5.0–6.6)
472
3.8
(3.5–4.2)
260
3.5
(3.1–4.0)
212
4.3
(3.7–5.0)
Brain
4507
5.3
(5.2–5.5)
3201
6.8
(6.6–7.1)
171
3.4
(2.9–4.0)
777
3.7
(3.4–4.0)
445
3.8
(3.4–4.2)
332
3.6
(3.1–4.1)
CUP
6686
8.5
(8.3–8.7)
4571
9.5
(9.2–9.8)
464
10.6
(9.6–11.7)
1019
6.7
(6.3–7.2)
585
6.2
(5.6–6.8)
434
7.5
(6.8–8.3)
NHL
5817
7.5
(7.3–7.7)
3861
8.2
(8.0–8.5)
265
5.9
(5.2–6.7)
1109
7.2
(6.7–7.7)
693
7.4
(6.8–8.1)
416
7.1
(6.4–7.8)
Leukemia
6685
8.6
(8.4–8.8)
4512
9.8
(9.5–10.1)
357
8.4
(7.5–9.4)
1179
6.2
(5.8–6.6)
598
5.9
(5.3–6.5)
581
6.7
(6.1–7.5)
All-sites-combined
145,045
185.9
(185.0–186.9)
95,579
200.7
(199.4–202.0)
10,567
250.4
(245.4–255.6)
22,838
152.0
(149.8–154.1)
12,691
138.9
(136.2–141.6)
10,147
174.1
(170.5–177.8)
Female
Oral Cavity and Pharynx
1452
1.4
(1.4–1.5)
960
1.6
(1.5–1.7)
100
1.7
(1.4–2.1)
179
0.9
(0.8–1.1)
104
0.9
(0.7–1.1)
75
1.0
(0.8–1.3)
Esophagus
1422
1.4
(1.3–1.5)
1038
1.7
(1.6–1.8)
105
1.8
(1.4–2.1)
138
0.7
(0.6–0.9)
70
0.6
(0.5–0.8)
68
0.9
(0.7–1.2)
Stomach
3282
3.3
(3.2–3.4)
1171
1.9
(1.8–2.0)
282
5.0
(4.4–5.6)
1077
5.2
(4.8–5.5)
746
5.6
(5.2–6.0)
331
4.4
(3.9–4.9)
Colorectum
12,559
12.2
(12.0–12.4)
8024
12.9
(12.6–13.2)
1112
19.4
(18.2–20.6)
1803
9.2
(8.8–9.7)
1034
8.5
(7.9–9.0)
769
10.5
(9.8–11.3)
Liver
4469
4.5
(4.3–4.6)
1907
3.2
(3.0–3.3)
323
5.4
(4.8–6.0)
1220
6.5
(6.1–6.9)
736
6.3
(5.9–6.8)
484
6.8
(6.2–7.5)
Gallbladder
785
0.8
(0.7–0.8)
333
0.5
(0.5–0.6)
44
0.8
(0.6–1.0)
294
1.6
(1.4–1.7)
221
1.9
(1.6–2.2)
73
1.0
(0.8–1.3)
Pancreas
9550
9.5
(9.3–9.7)
6029
9.9
(9.6–10.2)
753
13.3
(12.4–14.3)
1606
8.6
(8.2–9.1)
976
8.5
(8.0–9.1)
630
8.9
(8.2–9.7)
Lung
30,575
30.9
(30.5–31.2)
22,888
38.7
(38.2–39.3)
2223
38.7
(37.1–40.4)
2512
13.6
(13.1–14.2)
1334
11.8
(11.1–12.4)
1178
16.8
(15.9–17.9)
Melanoma
1599
1.6
(1.5–1.7)
1395
2.5
(2.3–2.6)
16
0.3
(0.2–0.4)
137
0.7
(0.6–0.8)
93
0.7
(0.6–0.9)
44
0.6
(0.4–0.8)
Breast
21,696
21.5
(21.2–21.8)
14,177
24.6
(24.1–25.0)
1960
32.7
(31.2–34.2)
3335
15.1
(14.6–15.7)
1977
13.9
(13.2–14.5)
1358
17.3
(16.3–18.2)
Cervix
2207
2.2
(2.2–2.3)
959
1.9
(1.8–2.1)
218
3.6
(3.1–4.1)
718
2.9
(2.7–3.1)
481
3.1
(2.8–3.4)
237
2.5
(2.2–2.9)
Endometrium
4444
4.4
(4.3–4.5)
2683
4.5
(4.3–4.7)
479
8.1
(7.4–8.9)
773
3.7
(3.4–4.0)
464
3.4
(3.1–3.8)
309
4.1
(3.7–4.6)
Ovary
7758
7.7
(7.6–7.9)
5186
8.9
(8.6–9.1)
447
7.6
(6.9–8.4)
1317
6.3
(6.0–6.7)
810
6.1
(5.7–6.6)
507
6.7
(6.1–7.4)
Kidney
2304
2.3
(2.2–2.4)
1406
2.3
(2.2–2.4)
133
2.3
(2.0–2.8)
528
2.7
(2.4–2.9)
281
2.3
(2.1–2.7)
247
3.3
(2.9–3.7)
Bladder
2071
2.0
(1.9–2.1)
1532
2.3
(2.2–2.5)
161
2.9
(2.5–3.4)
233
1.3
(1.1–1.5)
126
1.2
(1.0–1.4)
107
1.5
(1.2–1.8)
Brain
3489
3.5
(3.4–3.6)
2378
4.4
(4.2–4.6)
158
2.7
(2.3–3.1)
649
2.8
(2.6–3.0)
376
2.9
(2.6–3.2)
273
2.6
(2.2–2.9)
CUP
6229
6.1
(6.0–6.3)
4248
7.0
(6.8–7.2)
477
8.2
(7.5–9.0)
932
4.8
(4.5–5.1)
542
4.5
(4.1–5.0)
390
5.3
(4.7–5.8)
NHL
4715
4.6
(4.5–4.8)
3026
4.8
(4.6–5.0)
221
3.9
(3.4–4.5)
916
4.8
(4.5–5.2)
529
4.5
(4.1–5.0)
387
5.3
(4.8–5.9)
Leukemia
5158
5.1
(5.0–5.3)
3328
5.5
(5.4–5.8)
304
5.3
(4.7–6.0)
956
4.1
(3.9–4.4)
58
4.2
(3.8–4.6)
448
4.2
(3.8–4.7)
All-sites-combined
137,688
136.9
(136.2–137.7)
90,209
151.8
(150.8–152.8)
10,457
180.1
(176.6–183.6)
21,445
106.4
(104.9–107.9)
12,672
101.6
(99.8–103.5)
8773
114.7
(112.2–117.2)
Abbreviations: CUP cancers of unknown primary, NHL non-Hodgkin lymphoma; All-sites-combined includes all cancers, not only those listed here
a 2000 US Standard Population
b Includes all race/ethnicities
Table 3
Annual Age-Adjusted a Mortality Rates for Selected Cancers per 100,000, Texas, 2008–2012
 
All Combined b
Non-Latino White
Non-Latino Black
All Latino
Foreign-born Latino
US-born Latino
 
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
Male
Oral Cavity and Pharynx
2108
4.0
(3.8–4.2)
1447
4.3
(4.1–4.5)
274
5.6
(4.9–6.4)
325
2.7
(2.4–3.0)
103
2.0
(1.6–2.5)
222
3.3
(2.9–3.8)
Esophagus
3134
6.1
(5.9–6.4)
2265
6.8
(6.5–7.1)
298
6.5
(5.7–7.4)
517
4.8
(4.4–5.3)
150
3.0
(2.5–3.6)
367
6.2
(5.6–6.9)
Stomach
2462
4.9
(4.7–5.1)
1052
3.3
(3.1–3.5)
403
9.4
(8.4–10.5)
878
7.8
(7.3–8.4)
304
6.1
(5.3–6.9)
574
9.3
(8.5–10.1)
Colorectum
9295
19.0
(18.6–19.4)
5698
18.1
(17.6–18.6)
1357
30.3
(28.5–32.1)
2009
18.4
(17.6–19.3)
556
11.6
(10.6–12.8)
1453
24.1
(22.8–25.5)
Liver
6153
11.4
(11.1–11.7)
2956
8.6
(8.3–9.0)
903
16.3
(15.2–17.5)
2004
17.1
(16.3–18.0)
503
10.5
(9.5–11.6)
1501
23.0
(21.7–24.2)
Gallbladder
240
0.5
(0.4–0.6)
118
0.4
(0.3–0.4)
29
0.8
(0.5–1.1)
79
0.8
(0.6–1.0)
29
0.6
(0.4–1.0)
50
0.9
(0.6–1.1)
Pancreas
5861
11.9
(11.6–12.2)
3902
12.1
(11.7–12.5)
670
15.2
(14.0–16.5)
1152
10.7
(10.1–11.4)
373
7.9
(7.0–8.8)
779
13.1
(12.1–14.1)
Lung
27,382
56.9
(56.2–57.6)
20,235
63.1
(62.2–64.0)
3492
81.9
(78.9–84.9)
3114
32.2
(31.0–33.4)
1044
25.2
(23.5–26.9)
2070
37.9
(36.2–39.6)
Melanoma
1824
3.7
(3.6–3.9)
1654
5.3
(5.0–5.5)
21
0.5
(0.3–0.8)
136
1.3
(1.0–1.5)
54
1.2
(0.9–1.6)
82
1.3
(1.0–1.7)
Prostate
8058
19.8
(19.3–20.2)
5280
18.7
(18.2–19.2)
1264
39.6
(37.3–42.0)
1405
17.6
(16.7–18.6)
557
16.3
(14.9–17.8)
848
18.6
(17.3–19.9)
Kidney
3286
6.6
(6.4–6.8)
2123
6.6
(6.3–6.9)
298
6.7
(5.8–7.5)
807
7.1
(6.6–7.6)
232
4.6
(4.0–5.4)
575
9.2
(8.4–10.0)
Bladder
2769
6.5
(6.2–6.7)
2251
7.7
(7.3–8.0)
190
5.3
(4.5–6.2)
279
3.1
(2.7–3.5)
91
2.2
(1.7–2.8)
188
3.8
(3.2–4.4)
Brain
2618
4.9
(4.7–5.1)
1921
6.0
(5.7–6.2)
162
3.0
(2.5–3.6)
476
3.4
(3.0–3.7)
178
2.9
(2.5–3.5)
298
3.7
(3.2–4.2)
CUP
5015
10.3
(10.0–10.6)
3421
10.8
(10.4–11.2)
558
12.4
(11.3–13.6)
917
8.3
(7.7–8.9)
289
6.5
(5.7–7.4)
628
9.9
(9.1–10.8)
NHL
3593
7.7
(7.5–8.0)
2489
8.2
(7.9–8.5)
264
5.7
(5.0–6.5)
768
7.1
(6.6–7.7)
249
5.3
(4.6–6.1)
519
8.6
(7.8–9.5)
Leukemia
4260
9.2
(8.9–9.5)
2950
9.9
(9.5–10.2)
384
8.9
(8.0–10.0)
832
6.9
(6.3–7.4)
248
5.4
(4.6–6.3)
584
8.3
(7.5–9.1)
All-sites-combined
97,730
203.3
(202.0–204.6)
66,085
210.1
(208.5–211.8)
11,736
274.7
(269.3–280.3)
17,668
166.4
(163.8–169.1)
5629
124.8
(121.2–128.5)
12,039
201.4
(197.6–205.3)
Female
Oral Cavity and Pharynx
837
1.3
(1.2–1.4)
607
1.5
(1.4–1.7)
97
1.5
(1.2–1.8)
108
0.8
(0.7–1.0)
31
0.5
(0.4–0.8)
77
1.0
(0.8–1.3)
Esophagus
726
1.2
(1.1–1.3)
518
1.3
(1.2–1.4)
88
1.4
(1.1–1.7)
109
0.9
(0.7–1.0)
36
0.7
(0.5–1.0)
73
1.0
(0.8–1.2)
Stomach
1728
2.8
(2.7–2.9)
679
1.7
(1.6–1.9)
262
4.3
(3.8–4.9)
700
4.9
(4.5–5.2)
262
3.9
(3.5–4.5)
438
5.6
(5.0–6.1)
Colorectum
7762
12.5
(12.2–12.8)
5025
12.6
(12.2–12.9)
1213
19.8
(18.6–20.9)
1342
9.9
(9.3–10.4)
379
6.3
(5.6–7.0)
963
12.6
(11.8–13.5)
Liver
2831
4.6
(4.5–4.8)
1374
3.5
(3.3–3.7)
322
5.0
(4.5–5.6)
996
7.8
(7.3–8.3)
347
6.2
(5.5–6.9)
649
9.0
(8.3–9.7)
Gallbladder
474
0.8
(0.7–0.8)
229
0.6
(0.5–0.7)
55
0.9
(0.7–1.2)
172
1.3
(1.1–1.5)
72
1.2
(0.9–1.6)
100
1.3
(1.1–1.6)
Pancreas
5505
9.0
(8.8–9.3)
3552
8.9
(8.6–9.2)
790
13.5
(12.6–14.5)
1031
8.0
(7.5–8.5)
359
6.5
(5.8–7.2)
672
9.2
(8.5–9.9)
Lung
20,606
33.9
(33.5–34.4)
16,047
41.0
(40.3–41.6)
2318
38.4
(36.8–40.0)
1806
14.0
(13.4–14.7)
677
12.2
(11.2–13.2)
1129
15.5
(14.6–16.5)
Melanoma
892
1.4
(1.3–1.5)
765
2.0
(1.9–2.2)
25
0.4
(0.3–0.6)
93
0.6
(0.5–0.8)
40
0.6
(0.4–0.8)
53
0.7
(0.5–0.9)
Breast
13,264
21.2
(20.8–21.5)
8205
21.1
(20.7–21.6)
2212
33.5
(32.1–35.0)
2518
16.5
(15.8–17.2)
931
13.4
(12.5–14.3)
1587
19.2
(18.3–20.2)
Cervix
1733
2.8
(2.6–2.9)
800
2.3
(2.2–2.5)
286
4.1
(3.7–4.7)
608
3.6
(3.3–3.9)
233
3.2
(2.8–3.7)
375
4.1
(3.7–4.5)
Endometrium
2307
3.7
(3.5–3.9)
1266
3.2
(3.0–3.4)
420
6.9
(6.2–7.6)
545
3.7
(3.4–4.0)
187
2.9
(2.5–3.4)
358
4.4
(4.0–4.9)
Ovary
4512
7.3
(7.1–7.5)
3092
7.9
(7.7–8.2)
425
7.0
(6.3–7.7)
880
6.1
(5.7–6.5)
304
4.7
(4.1–5.3)
576
7.2
(6.6–7.8)
Kidney
1834
3.0
(2.8–3.1)
1119
2.8
(2.6–3.0)
204
3.3
(2.9–3.8)
474
3.6
(3.2–3.9)
159
2.7
(2.3–3.2)
315
4.3
(3.8–4.8)
Bladder
1116
1.8
(1.7–2.0)
804
2.0
(1.8–2.1)
146
2.6
(2.2–3.0)
155
1.2
(1.0–1.4)
49
1.0
(0.7–1.3)
106
1.5
(1.2–1.8)
Brain
2096
3.3
(3.2–3.5)
1517
4.1
(3.9–4.3)
141
2.1
(1.8–2.5)
388
2.3
(2.1–2.6)
120
2.2
(1.6–2.9)
268
2.8
(2.5–3.2)
CUP
4169
6.8
(6.6–7.0)
2802
7.0
(6.8–7.3)
508
8.3
(7.6–9.1)
751
5.6
(5.2–6.0)
276
4.8
(4.2–5.4)
475
6.3
(5.7–6.9)
NHL
2831
4.7
(4.5–4.8)
1952
4.9
(4.7–5.1)
201
3.3
(2.8–3.8)
613
4.7
(4.3–5.1)
231
4.2
(3.6–4.8)
382
5.2
(4.6–5.7)
Leukemia
3218
5.3
(5.1–5.5)
2189
5.6
(5.4–5.9)
299
5.0
(4.4–5.6)
644
4.1
(3.7–4.4)
206
3.4
(2.9–4.0)
438
4.7
(4.2–5.2)
All-sites-combined
85,288
138.6
(137.6–139.5)
56,814
145.0
(143.8–146.2)
10,954
176.8
(173.4–180.2)
15,405
110.1
(108.3–111.9)
5410
89.0
(86.4–91.6)
9995
127.7
(125.1–130.3)
Abbreviations: CUP cancers of unknown primary, NHL non-Hodgkin lymphoma; All-sites-combined includes all cancers, not only those listed here
a 2000 US Standard Population
b Includes all race/ethnicities
Compared to NLWs, the risk of cancer death for Latinos in aggregate for all-cancers-combined was 23% and 26% lower in Texas and California, respectively, for both sexes combined ( p < 0.05). However, in both states, significantly higher mortality was observed for stomach, cervix and gall bladder cancers for US-born and foreign-born Latinos compared to NLWs. Patterns for certain cancers, including liver, kidney and colorectal cancer, were markedly different between US-born and foreign-born Latinos, with significantly higher mortality seen in the US-born, consistent across both states. The largest difference was seen in liver cancer: US-born Latino men had 2.8 (95% CI: 2.5–3.2) and 2.7 (95% CI: 2.2–3.4) times higher liver cancer mortality than NLWs in California and Texas, respectively, while ratios for foreign-born Latino men were 1.2 (95%CI: 1.1–1.4) in California and 1.1 (95% CI: 0.9–1.3) in Texas (Table 4).
Table 4
Mortality Rate Ratios a for Selected Cancers by Latino Ethnicity and Birthplace, CA and TX, 2008–2012
   
California
Texas
 
Non-Latino White
All Latino
US-born Latino
Foreign-born Latino
All Latino
US-born Latino
Foreign-born Latino
 
Referent
RR
95% CI
RR
95% CI
RR
95% CI
RR
95% CI
RR
95% CI
RR
95% CI
Male
Oral Cavity and Pharynx
1.00
0.57
(0.50–0.64)
0.74
(0.63–0.87)
0.46
(0.39–0.54)
0.62
(0.54–0.69)
0.79
(0.68–0.91)
0.42
(0.34–0.51)
Esophagus
1.00
0.56
(0.51–0.61)
0.74
(0.66–0.84)
0.45
(0.39–0.50)
0.65
(0.59–0.72)
0.86
(0.77–0.96)
0.41
(0.35–0.48)
Stomach
1.00
2.01
(1.86–2.18)
1.91
(1.66–2.18)
2.05
(1.82–2.30)
2.33
(2.13–2.55)
2.82
(2.55–3.13)
1.75
(1.54–1.99)
Colorectum
1.00
0.92
(0.88–0.97)
1.25
(1.17–1.34)
0.71
(0.66–0.76)
1.02
(0.96–1.07)
1.36
(1.28–1.45)
0.60
(0.55–0.66)
Liver
1.00
1.80
(1.69–1.92)
2.83
(2.52–3.18)
1.21
(1.07–1.37)
1.94
(1.68–2.25)
2.73
(2.22–3.36)
1.06
(0.85–1.32)
Gallbladder
1.00
2.14
(1.65–2.78)
2.59
(1.85–3.64)
1.83
(1.32–2.56)
2.07
(1.56–2.76)
2.40
(1.72–3.35)
1.67
(1.11–2.52)
Pancreas
1.00
0.83
(0.78–0.88)
0.99
(0.91–1.08)
0.73
(0.67–0.79)
0.87
(0.82–0.93)
1.09
(1.01–1.17)
0.62
(0.56–0.69)
Lung
1.00
0.48
(0.44–0.53)
0.57
(0.54–0.61)
0.44
(0.42–0.47)
0.46
(0.40–0.52)
0.56
(0.48–0.64)
0.34
(0.29–0.39)
Prostate
1.00
0.85
(0.81–0.89)
0.95
(0.88–1.02)
0.77
(0.73–0.83)
0.94
(0.88–1.00)
1.01
(0.92–1.09)
0.86
(0.78–0.95)
Kidney
1.00
1.06
(0.98–1.15)
1.44
(1.30–1.61)
0.82
(0.73–0.92)
1.09
(1.00–1.18)
1.45
(1.32–1.59)
0.67
(0.58–0.77)
Bladder
1.00
0.43
(0.38–0.47)
0.52
(0.44–0.60)
0.37
(0.32–0.42)
0.41
(0.36–0.46)
0.49
(0.42–0.57)
0.31
(0.25–0.38)
Brain
1.00
0.51
(0.46–0.56)
0.55
(0.48–0.64)
0.49
(0.43–0.55)
0.56
(0.50–0.62)
0.61
(0.53–0.70)
0.49
(0.42–0.58)
CUP
1.00
0.69
(0.64–0.75)
0.82
(0.74–0.92)
0.61
(0.55–0.67)
0.76
(0.71–0.82)
0.96
(0.88–1.05)
0.53
(0.47–0.60)
NHL
1.00
0.89
(0.82–0.96)
0.94
(0.84–1.04)
0.86
(0.78–0.94)
0.90
(0.83–0.98)
1.15
(1.00–1.31)
0.65
(0.56–0.76)
Leukemia
1.00
0.60
(0.56–0.66)
0.71
(0.63–0.81)
0.56
(0.49–0.63)
0.71
(0.65–0.79)
0.90
(0.79–1.02)
0.51
(0.44–0.60)
All-sites-combined
1.00
0.75
(0.58–0.96)
0.92
(0.90–0.94)
0.64
(0.63–0.65)
0.78
(0.76–0.80)
1.01
(0.93–1.09)
0.55
(0.51–0.60)
Female
Oral Cavity and Pharynx
1.00
0.55
(0.46–0.67)
0.72
(0.56–0.91)
0.44
(0.34–0.57)
0.49
(0.40–0.61)
0.65
(0.51–0.83)
0.30
(0.20–0.43)
Esophagus
1.00
0.42
(0.34–0.51)
0.61
(0.47–0.79)
0.28
(0.20–0.38)
0.64
(0.52–0.78)
0.76
(0.59–0.97)
0.47
(0.33–0.66)
Stomach
1.00
2.52
(2.29–2.77)
2.37
(2.05–2.75)
2.65
(2.28–3.08)
2.86
(2.56–3.18)
3.24
(2.87–3.66)
2.37
(2.05–2.74)
Colorectum
1.00
0.70
(0.66–0.74)
0.85
(0.79–0.92)
0.58
(0.54–0.63)
0.77
(0.73–0.82)
1.00
(0.93–1.07)
0.49
(0.44–0.55)
Liver
1.00
2.04
(1.86–2.23)
2.25
(1.95–2.60)
1.81
(1.57–2.08)
1.98
(1.68–2.34)
2.36
(2.00–2.79)
1.51
(1.28–1.81)
Gallbladder
1.00
2.76
(2.33–3.28)
2.05
(1.58–2.66)
3.28
(2.70–3.98)
2.16
(1.77–2.64)
2.30
(1.82–2.91)
2.00
(1.52–2.60)
Pancreas
1.00
0.87
(0.82–0.92)
0.94
(0.86–1.02)
0.82
(0.76–0.89)
0.88
(0.82–0.94)
1.03
(0.94–1.11)
0.69
(0.62–0.77)
Lung
1.00
0.35
(0.32–0.39)
0.45
(0.40–0.50)
0.29
(0.26–0.33)
0.32
(0.28–0.37)
0.35
(0.31–0.41)
0.27
(0.23–0.32)
Breast
1.00
0.63
(0.60–0.66)
0.73
(0.68–0.78)
0.55
(0.52–0.59)
0.79
(0.75–0.83)
0.92
(0.87–0.98)
0.64
(0.59–0.68)
Cervix
1.00
1.51
(1.34–1.69)
1.45
(1.23–1.71)
1.61
(1.41–1.83)
1.57
(1.38–1.79)
1.81
(1.46–2.24)
1.41
(1.11–1.78)
Endometrium
1.00
0.88
(0.81–0.96)
1.00
(0.89–1.13)
0.79
(0.71–0.89)
1.20
(1.03–1.39)
1.44
(1.22–1.70)
0.90
(0.74–1.09)
Ovary
1.00
0.71
(0.67–0.76)
0.81
(0.73–0.89)
0.65
(0.59–0.71)
0.78
(0.72–0.84)
0.93
(0.85–1.02)
0.59
(0.53–0.67)
Kidney
1.00
1.29
(1.16–1.44)
1.60
(1.39–1.84)
1.07
(0.92–1.23)
1.27
(1.14–1.41)
1.52
(1.34–1.72)
0.95
(0.80–1.12)
Bladder
1.00
0.54
(0.46–0.64)
0.67
(0.54–0.82)
0.45
(0.36–0.56)
0.63
(0.53–0.74)
0.76
(0.62–0.93)
0.45
(0.34–0.61)
Brain
1.00
0.57
(0.51–0.63)
0.60
(0.51–0.71)
0.55
(0.48–0.63)
0.57
(0.50–0.64)
0.78
(0.63–0.91)
0.42
(0.32–0.55)
CUP
1.00
0.71
(0.66–0.77)
0.80
(0.72–0.90)
0.64
(0.58–0.72)
0.78
(0.72–0.85)
0.89
(0.81–0.93)
0.64
(0.56–0.72)
NHL
1.00
1.00
(0.92–1.09)
1.14
(1.02–1.28)
0.90
(0.80–1.00)
0.96
(0.87–1.05)
1.05
(0.94–1.17)
0.83
(0.73–0.96)
Leukemia
1.00
0.72
(0.65–0.81)
0.74
(0.64–0.86)
0.64
(0.56–0.73)
0.73
(0.64–0.83)
0.87
(0.74–1.03)
0.58
(0.48–0.70)
All-sites-combined
1.00
0.73
(0.58–0.92)
0.80
(0.78–0.82)
0.64
(0.63–0.66)
0.76
(0.74–0.77)
0.89
(0.86–0.91)
0.60
(0.58–0.62)
Abbreviations: CUP cancers of unknown primary, NHL non-Hodgkin lymphoma; All-sites-combined includes all cancers, not only those listed here
a Negative binomial regression rate ratios adjusted for age groups 40+ years

Discussion

This is the first detailed analysis of cancer mortality by site for Latinos disaggregated by birthplace, US-born vs foreign-born. While mortality rates for all Latinos combined were lower than for NLWs as expected, the profile changed substantially when birthplace was considered. Among US-born Latinos, males in Texas had similar overall mortality rates to NLWs (RR = 1.01; 95% CI 0.93–1.09), while Texas females were 11% lower; similarly, in California, mortality rates were 8% and 20% lower for males and females, respectively. This unprecedented proximity of overall rates between NLWs and US-born Latino populations runs counter to the prevailing narrative of Latinos having significantly better cancer outcomes [ 1, 16].
Theories of the negative effects of acculturation [ 8] might lead one to think that US-born Latino cancer mortality outcomes are simply converging with the majority NLW population. However, this is not uniformly the case; substantial heterogeneity was seen by cancer site. Non-Latino whites were more vulnerable to lung, breast, bladder and melanoma mortality, while US-born Latino mortality was excessive for liver, kidney and CRC (in males), as well as for stomach, cervix and gall bladder, previously documented [ 1]. Some of these results align with existing knowledge of racial/ethnic patterns in risk factors: for lung, breast, cervical, and stomach cancers, differences in prevalence of risk factors such as smoking, reproductive patterns, human papillomavirus (HPV) and Helicobacter pylori infection are explanatory [ 16, 17].
Additional results from this study are surprising, such as the similar or slightly higher rates for some cancers for US-born Latinos compared to NLWs. These include pancreas, endometrium, prostate cancer, and non-Hodgkin lymphoma (NHL), not previously shown to be this high in a predominantly Mexican Latino population. While not the sole risk factor, obesity is associated with increased risk of liver, kidney, CRC, pancreas and endometrial cancers [ 18]. Thus, the high prevalence of obesity documented among US-born Latinos [ 19, 20] suggests this should be a target for intervention.
Unique patterns deserving of further discussion include liver, kidney and CRC.

Liver

The exceedingly high liver cancer mortality found in Latinos, especially among the US-born, whose rates are more than double those of NLWs, constitutes a true disparity. Unlike for NLWs, liver cancer was consistently one of the top four main causes of cancer death for both US-born and foreign-born male and female Latino populations. Our results confirm those from a previous mortality study using data through 2002 [ 21], as well as more recent incidence studies [ 22, 23].
Historically, liver cancer has been more common in developing countries and among US Latino and Asian immigrant populations, a pattern driven by their higher prevalence of hepatitis B infection (HBV) [ 24, 25]. With the implementation of HBV vaccination programs globally, this determinant of liver cancer, while still relevant, has reduced in prominence in the US [ 24, 26]. Instead, chronic infection with the hepatitis C virus (HCV) has been linked to the recent liver cancer incidence increases seen in the US, especially among the birth cohort of 1945–1965 [ 24, 26]. HCV infection in the US most often results from intravenous drug use and/or past transfusions with contaminated blood [ 26]. With the shifting roles of these two viral hepatitis infections, relative patterns for liver cancer between racial/ethnic groups in the US have also changed.
In our study, we found distinct patterns by gender. Foreign-born Latino men had liver cancer mortality rates similar to (California) or only slightly higher than (Texas) the referent NLW population. However, foreign-born Latina women in both states had significantly higher rates than NLW women, findings that are consistent with a recent study of diverse foreign-born Latinos in Florida [ 4]. Among US-born Latinos, liver cancer mortality rates were also higher for females compared to their NLW counterparts; however, they were exceedingly high for males, almost three times higher than NLWs in both states. While Latinos, especially the US-born, have high prevalence of some important risk factors for liver cancer [ 27], including obesity [ 9], diabetes [ 20], and heavy alcohol consumption among men [ 28], differences in HCV prevalence by gender and birthplace more likely explain the unique mortality patterns observed in this study.
Previous studies have attributed approximately 20% of US liver cancer cases to infection with HCV [ 27, 29]. However, these estimates are highly dependent upon methodology, especially the inclusion of relevant confounders. Bypassing these problems by using direct linkage between cancer registry data and viral hepatitis data, a recent study in New York City (NYC) found that a remarkable 40% of all NLW, 48% of all Latino, and 51% of all NLB new liver cancer cases in NYC were HCV-positive [ 30]. These results suggest that the role of HCV infection in the liver cancer “epidemic” may have been thus far underestimated. Additionally, regarding birthplace and HCV, researchers using NHANES data showed that US-born Latino males, with an elevated age-adjusted prevalence of HCV of 5.4%, have an approximately 8-times higher prevalence of HCV infection than their foreign-born Latino male counterparts [ 31]. Yet, among females, the prevalence ratio of HCV between US-born and foreign-born is comparatively lower, only 4-fold [ 31]. Furthermore, the overall prevalence of HCV among foreign-born Latinos was found to be lower than NLWs of both sexes [ 32]. Collectively, these data point towards the role of HCV prevalence in potentially explaining the differences in liver cancer mortality not only between US-born and foreign-born Latinos, but also between Latino males and females in relation to their NLW counterparts. Further research is needed to assess these gender-specific differences, especially given the likelihood that causal factors other than HCV play a larger role in liver cancer among the foreign-born, particularly among women. Moreover, this liver cancer disparity among US-born Latinos warrants specific interventions, possibly including targeted HCV screening and treatment as well as other public health measures aimed at reducing non-viral liver cancer risk factors in the Latino community, including obesity and metabolic disorders.

Kidney

Mortality rates for kidney cancer were 44% higher in US-born Latino males than NLWs, and 52% (TX) and 60% (CA) higher in US-born females; foreign-born Latinos had lower (men) or similar (women) mortality from kidney cancer compared to NLWs. Obesity likely explains much of this disparity: the population-attributable fraction of overweight/obesity as a risk factor for kidney cancer has been estimated at over 40% [ 18]. US-born Latinos, especially US-born Mexicans, have a much higher prevalence of obesity than NLWs; historically foreign-born Latinos have had relatively lower prevalence of obesity, especially men [ 19, 20, 33]. Two additional known risk factors for kidney cancer are smoking and hypertension, the latter independent of obesity [ 34]. Yet, Latinos, even the US-born, smoke less than NLWs [ 20]. Notably, while hypertension prevalence is similar between Latinos and NLWs, treatment and control of hypertension is much lower in Latinos [ 20].
The high kidney cancer mortality rates found here in US-born Latinos approach national rates recorded among American Indians [ 35], previously documented with the highest kidney cancer burden in the US, for whom prevalence of obesity, smoking, and hypertension are universally high [ 16, 36]. These risk factors are common correlates of lower socio-economic status, a shared feature between American Indian and US-born Latinos. Both minority populations are disadvantaged in education level and poverty, as well as access to quality healthcare [ 20, 35]. The unique vulnerability of US-born Latino and American Indian populations to kidney cancer requires additional investigation and public health attention to fully understand and eliminate this disparity.

Colorectal

In both states, US-born Latino men showed approximately 30% higher colorectal cancer mortality than NLW men, while mortality for US-born Latino women was only slightly lower (CA) or equivalent (TX) to their NLW counterparts. These findings contrast with previously recorded national rate ratios between Latinos in aggregate and NLWs during the same time period, 0.9 for men and 0.7 for women [ 1], demonstrating the importance of examining Latino cancer outcomes by birthplace. CRC risk factors that are high among US-born Latinos include obesity [ 9], diabetes [ 20], and heavy alcohol consumption among men [ 28], as previously mentioned. Additionally, low CRC screening among Latinos, especially men [ 20, 37], may further explain the disparity observed here. While other populations have seen declines in CRC mortality, attributed to increases in CRC screening [ 1], one recent study in California showed that low screening was driving a stable CRC mortality trend for Latinos [ 38]. Our findings suggest the same is happening in Texas; thus, this may be a problem with a national dimension. Given the high CRC mortality for US-born Latinos, continued efforts to increase the uptake of CRC screening and expand health care access are warranted in Latino communities.
This study presents valuable new data that provides evidence of cancer mortality disparities in the Latino population in the United States. Specific Latino ethnic group has been shown to be a major determinant of cancer mortality differences, as seen in Florida for Cubans, Puerto Ricans, Mexicans, Central and South Americans, and Dominicans [ 4]. However, independent of ethnic group, birthplace is a major determinant and confounder of cancer mortality rates, as shown here. Therefore, to generalize Latino cancer outcomes in the US without considering both ethnic group and birthplace is counterproductive. Across the US, regional variation in birthplace is remarkable, and confounds aggregate Latino rates by state and especially nationally. For example, in Florida an overwhelming 92% of Latino cancer decedents between 2008 and 2012 were foreign-born [ 4], while in this study only 43% were foreign-born in California and 33% in Texas. As an additional strength, our study benefits from very high completeness (>99%) of birthplace information for all decedents, which, combined with ethnicity and text descriptors, allowed for unprecedented reliable classification of Latinos by birthplace.
While it is possible that terminally ill Latinos could have returned to their home countries of origin to die, this out-migration has been found to be very small among Latinos [ 39, 40], and furthermore, would not affect the rates for US-born Latinos. Because we have previously shown Latino origin/ethnic group to be a major confounder in Latino cancer studies at large [ 4], we calculated disaggregated rates for Mexicans, Central Americans, and Other Latinos for the state of California, presented in Table 5. However, in California, 81% of all Latino decedents in our study were of Mexican origin, while Texas was even higher at 91%. Therefore, for these two states, not including origin/ethnic group data is unlikely to have biased our analysis.
Table 5
Annual Age-Adjusted a Mortality Rates for Latino Ethnic Groups per 100,000, California, 2008–2012
 
All Latino a
Mexican
Central American
South American
Caribbean
 
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
N
Rate
95% CI
MALE
Oral Cavity and Pharynx
400
2.5
(2.2–2.7)
332
2.5
(2.2–2.8)
23
2.0
(1.1–3.1)
<10
1.5
(0.6–3.0)
22
3.7
(2.3–5.6)
Esophagus
667
4.4
(4.0–4.7)
558
4.4
(4.0–4.8)
40
4.0
(2.7–5.6)
14
2.6
(1.3–4.4)
31
5.4
(3.6–7.7)
Stomach
1316
8.2
(7.7–8.7)
1051
8.1
(7.6–8.6)
166
11.6
(9.5–14.0)
53
9.1
(6.7–12.0)
30
5.2
(3.5–7.5)
Colorectum
2380
15.5
(14.9–16.2)
1996
15.6
(14.9–16.4)
125
9.1
(7.3–11.3)
82
15.4
(12.1–19.4)
107
19.8
(16.1–23.9)
Liver
2360
14.0
(13.4–4.6)
2034
14.6
(13.9–15.3)
154
11.9
(9.8–14.4)
53
9.4
(6.9–12.5)
72
12.1
(9.4–15.3)
Gallbladder
102
0.7
(0.6–0.9)
86
0.7
(0.6–0.9)
<10
0.5
(0.2–1.2)
<10
1.1
(0.3–2.6)
<10
0.2
(0.0–1.0)
Pancreas
1598
10.7
(10.1–11.2)
1315
10.6
(10.0–11.2)
116
10.0
(8.0–12.4)
70
13.5
(10.3–17.2)
56
10.1
(7.5–13.1)
Lung
3586
26.6
(25.7–27.5)
2925
26.5
(25.4–27.5)
171
17.1
(14.3–20.2)
162
29.3
(24.7–34.4)
206
37.9
(32.8–43.5)
Melanoma
186
1.1
(1.0–1.3)
141
1.0
(0.9–1.2)
12
0.9
(0.4–1.7)
13
2.1
(1.1–3.7)
<10
1.4
(0.6–2.7)
Prostate
2212
19.2
(18.4–20.1)
1795
18.9
(18.1–19.9)
132
16.8
(13.8–20.2)
107
22.9
(18.6–27.9)
109
22.3
(18.3–26.9)
Kidney
890
5.6
(5.2–6.0)
754
5.7
(5.3–6.2)
44
2.7
(1.8–3.8)
30
5.1
(3.3–7.6)
38
4.5
(2.8–6.7)
Bladder
472
3.8
(3.5–4.2)
377
3.6
(3.2–4.0)
23
3.3
(2.0–4.9)
26
5.7
(3.7–8.2)
22
7.0
(4.9–9.6)
Brain
777
3.7
(3.4–4.0)
619
3.6
(3.3–3.9)
84
4.2
(3.2–5.6)
32
4.9
(3.3–7.1)
23
3.8
(2.4–5.8)
CUP
1019
6.7
(6.3–7.2)
838
6.6
(6.2–7.1)
69
5.5
(4.0–7.2)
44
8.3
(5.9–11.2)
39
6.8
(4.8–9.4)
NHL
1109
7.2
(6.7–7.7)
916
7.2
(6.7–7.7)
93
7.6
(5.9–9.7)
39
6.9
(4.8–9.6)
41
7.2
(5.1–9.8)
Leukemia
1179
6.2
(5.8–6.6)
970
6.0
(5.5–6.4)
105
6.6
(5.1–8.3)
42
7.3
(5.1–10.0)
32
5.8
(3.9–8.2)
All-sites-combined
22,838
152.0
(149.8–154.1)
18,863
151.6
(149.2–153.9)
1550
127.2
(119.6–135.1)
871
161.2
(150.1–173.0)
927
169.5
(158.6–181.0)
FEMALE
Oral Cavity and Pharynx
179
0.9
(0.8–1.1)
136
0.9
(0.7–1.1)
23
1.2
(0.7–1.8)
<10
1.1
(0.5–2.1)
<10
0.9
(0.4–2.0)
Esophagus
138
0.7
(0.6–0.9)
104
0.7
(0.6–0.8)
17
0.9
(0.5–1.4)
<10
0.8
(0.3–1.7)
<10
0.7
(0.2–1.7)
Stomach
1077
5.2
(4.8–5.5)
805
4.9
(4.5–5.2)
193
8.2
(7.1–9.6)
47
5.7
(4.2–7.6)
10
1.4
(0.6–2.5)
Colorectum
1803
9.2
(8.8–9.7)
1376
8.9
(8.4–9.4)
188
8.8
(7.6–10.2)
89
10.9
(8.7–13.5)
89
12.2
(9.8–15.0)
Liver
1220
6.5
(6.1–6.9)
987
6.7
(6.3–7.2)
150
7.4
(6.2–8.7)
36
4.4
(3.1–6.2)
34
4.7
(3.3–6.6)
Gallbladder
294
1.6
(1.4–1.7)
227
1.5
(1.3–1.7)
44
2.3
(1.7–3.1)
12
1.5
(0.8–2.7)
<10
1.0
(0.4–2.1)
Pancreas
1606
8.6
(8.2–9.1)
1267
8.7
(8.2–9.2)
151
7.5
(6.3–8.8)
75
9.2
(7.2–11.6)
58
8.1
(6.1–10.5)
Lung
2512
13.6
(13.1–14.2)
1993
13.8
(13.2–14.4)
207
10.4
(8.9–11.9)
112
13.6
(11.2–16.4)
115
16.3
(13.4–19.5)
Melanoma
137
0.7
(0.6–0.8)
110
0.7
(0.5–0.8)
<10
0.3
(0.1–0.6)
<10
0.7
(0.2–1.5)
<10
0.7
(0.2–1.6)
Breast
3335
15.1
(14.6–15.7)
2672
15.1
(14.5–15.7)
317
12.7
(11.3–14.3)
133
15.2
(12.7–18.1)
129
18.1
(15.1–21.5)
Cervix
718
2.9
(2.7–3.1)
584
2.9
(2.7–3.2)
101
4.0
(3.2–5.0)
16
1.8
(1.0–2.9)
11
1.6
(0.7–2.8)
Endometrium
773
3.7
(3.4–4.0)
632
3.8
(3.5–4.1)
81
3.5
(2.8–4.4)
24
2.7
(1.7–4.1)
18
2.5
(1.5–3.9)
Ovary
1317
6.3
(6.0–6.7)
1033
6.3
(5.9–6.7)
172
7.3
(6.2–8.5)
47
5.3
(3.9–7.1)
36
5.0
(3.5–6.9)
Kidney
528
2.7
(2.4–2.9)
452
2.9
(2.6–3.2)
40
1.8
(1.2–2.4)
17
1.1
(0.5–2.1)
<10
1.2
(0.5–2.3)
Bladder
233
1.3
(1.1–1.5)
179
1.3
(1.1–1.5)
22
1.3
(0.8–1.9)
<10
2.1
(1.2–3.3)
<10
1.2
(0.5–2.3)
Brain
649
2.8
(2.6–3.0)
497
2.6
(2.4–2.9)
84
3.7
(2.9–4.6)
32
3.8
(2.6–5.4)
18
2.5
(1.5–4.0)
CUP
932
4.8
(4.5–5.1)
757
5.0
(4.6–5.4)
77
3.5
(2.7–4.4)
44
5.4
(3.9–7.2)
34
4.7
(3.2–6.5)
NHL
916
4.8
(4.5–5.2)
713
4.8
(4.4–5.1)
101
4.9
(4.0–6.1)
39
4.7
(3.3–6.4)
29
4.0
(2.7–5.8)
Leukemia
956
4.1
(3.9–4.4)
768
4.0
(3.7–4.3)
105
4.5
(3.6–5.5)
29
3.6
(2.4–5.3)
36
4.9
(3.4–6.8)
All-sites-combined
21,445
106.4
(104.9–107.9)
16,969
106.0
(104.4–107.7)
2295
104.0
(99.5–108.5)
886
106.8
(99.8–114.1)
725
101.6
(94.3–109.3)
Central American (major group, Salvadorans, 48%); South American (major group, Peruvians, 28%); Caribbean includes Puerto Ricans, Cubans, Dominicans
Abbreviations: CUP cancers of unknown primary, NHL non-Hodgkin lymphoma; All-sites-combined includes all cancers, not only those listed here
a 2000 US Standard Population
b Includes those of Spaniard (European Spanish) origin or birthplace Spain
Mortality is primarily a function of cancer incidence; however, it is possible that limited quality health care access for Latinos results in poor cancer survival, thus impacting the mortality burden. While analyzing any differential survival between US-born and foreign-born Latinos can be problematic [ 41, 42], the Surveillance, Epidemiology and End Results (SEER) program, which conducts follow-up for more than 95% of all cancer patients, shows almost no differences in overall survival between NLWs and its Latino population, overwhelmingly Mexican [ 43]. Therefore, the mortality differences seen in our study are likely driven by differences in cancer incidence, rather than survival. Notwithstanding, future accurate survival studies with complete follow-up, especially in Texas, a non-SEER state, are warranted to assess the contribution of differential survival to these mortality patterns.

Conclusions

There are two main conclusions to be drawn from this study. First, in order for cancer indicators for Latinos to be accurate and useful in cancer prevention and control efforts, both ethnic group and birthplace must be taken into consideration. The Latino “advantage” in mortality does apply to foreign-born Latinos, but less so to US-born Latinos, suggesting that in aggregate, foreign-born status is the advantage, rather than ethnicity per se. Moreover, as previously suggested, the cancer advantage for Latinos seems, at least for men, to be largely an effect of tobacco smoking trends [ 19, 44]. If the excess in mortality from lung cancer (and melanoma whose rate is inherently higher) among NLWs were subtracted, overall mortality rates among US-born Latino men would be higher than NLWs in Texas, and similar in California.
Secondly, but more importantly, this elevated cancer mortality among US-born Latinos is an important and worrisome indicator. Since 2000, the share of foreign-born among Latinos has been declining, and birth has replaced migration as the primary source of population growth [ 14]. The role of negative acculturation among Latinos should be further studied given that the prevalence of many factors implicated in increased cancer mortality - HCV, obesity, diabetes, and uncontrolled hypertension – are now higher among US-born Latinos than NLWs, the host population to which Latinos supposedly acculturate. Already, current data from the California Health Information Survey shows only minimal differences between US-born and foreign born Latinos for smoking, obesity, and diabetes [ 45]. Thus, the offsetting of cancer rates by the “healthier” foreign-born among Latinos will not be a long-lasting trend. As US-born Latino rates for some cancers begin to approximate American Indian and African American populations, long known to be disadvantaged, the narrative describing Latino cancer outcomes will need to align with critical examination of the role of social determinants of health among US minority populations.

Acknowledgements

The authors would like to thank Fabienne Laraque, MD, MPH, Director, Viral Hepatitis Program, BCD, NYC, DOHMH for her assistance.

Funding

Paulo S. Pinheiro is partially funded by the National Institute of General Medical Sciences (8 P20 GM103440–11). NIGMS sponsors his research on disparities in cancer but has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

Availability of data and materials

Restrictions from California and Texas Departments of Health apply to the availability of these data. The authors themselves are unauthorized to share the individual-level data.

Ethics approval and consent to participate

This study was approved by the University of Nevada, Las Vegas Institutional Review Board; excluded as “Not Human Subjects Research” under Protocol # 798947-1. Data use agreements were obtained from California and Texas. The mortality data that support the findings of this study were obtained by special permission from the State of California, Department of Public Health, Center for Health Statistics and Informatics, Health Information and Research Section and the State of Texas, Texas Department of State Health Services, Center for Health Statistics.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
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