Cancer is the second leading cause of death among adult Hispanics. Cancer occurrences vary across Hispanic subgroups because of regional, demographic, geographic, socioeconomic, behavioral and/or genetic differences [1
]. From epidemiologic, public health, cancer control and social science perspectives, it is important to identify populations that differ in disease patterns, risk patterns and disease outcomes [4
]. However, most of the data available, both at the national and state level, report cancer statistics for all Hispanics as an aggregate group [3
], masking important heterogeneity in overall mortality across subgroups that fall under the Hispanic label [5
Hispanics are the fastest growing and largest minority group in the United States (13% vs. 11% of African-Americans) [6
]. By the year 2050, an estimated 102 million Hispanics will reside in the United States representing nearly 25% of the total U.S. population. Florida has one of the highest percentages of Hispanics in the nation—nearly 20% of the state population [7
]. From 1990 to 2000, the Florida Hispanic population experienced a 70% increase and is the fastest growing ethnic group in the state.
The term Hispanic
, created by the U.S. Office of Management and Budget (OMB) in the 1970s, is a socially and politically constructed term first used in the 1980 census [8
]. With this inclusion, U.S. Hispanics gained political and economic leverage to advance and exert influence over state and national policies [9
]. The OMB acknowledges that there are no anthropological or biological bases to support these classifications and that they are sociopolitical constructs [11
Overall, Florida residents experience similar illness burden and mortality as the general U.S. population. However, the state economy and demographic population composition distinguish the state in several important ways giving rise to a unique set of public health and clinical considerations. Florida’s large population is diverse with regard to age, ethnicity and international immigration. These features shape the population’s general literacy level, English language proficiency and employment opportunities, which in turn are key variables that affect health status and access to health care. As a gateway to Latin America and the Caribbean, Florida also has a diverse foreign-born population (12.9 % in 1990, and 16.7% of the population in 2000 compared to 11.1% nationally) [13
], with 72.8% of this population born in Latin America. And this is a different experience than other states with large Hispanic populations such as California and Texas. In 1990, the foreign born population in California and Texas were 17.3% and 8.7%, respectively. By 2000, California and Texas had increased their foreign born population to 23.5% and 13%, respectively. In 2000, Hispanics comprised over 54.8% of the foreign born population in California, whereas in Texas Hispanics comprised 74.7% of the foreign born. In total, Hispanics comprise over 30% of the populations of California and Texas. The overwhelming majority of Hispanics are of Mexican descent (83% in Texas and California vs. 16% in Florida) [7
] underscoring the need to make state-by-state inter-ethnic comparisons.
Hispanics in Florida have a similar annual death rate to Hispanics nationwide for all cancer sites combined (130.6/100,000 vs. 129.1/100,000, respectively). While morbidity and mortality rates for all-cancer sites in Florida are similar to the general U.S. population, some cancer-specific morbidity and mortality rates differ. For example, cervical cancer incidence is higher in Florida than in the United States [14
]. The breast cancer mortality rate in Florida is the third highest in the nation [14
]. Even though the average annual age-adjusted death rates for lung, breast and colorectal cancer are lower for Hispanics compared to other ethnic groups, the rates are higher for Hispanics in Florida than the national Hispanic averages [15
]. In 1999, during the study period, cancer accounted for 24% of all deaths in Florida [16
Similar to other cancer data collection systems, the Florida Cancer Data System (FCDS) relies on medical records which often do not include information on country of origin for Hispanic patients. The surveillance, epidemiology and end results (SEER) datasets collected by the National Cancer Institute categorize individuals as Hispanic using a variety of methods including birthplace, last name, and self-identification of Hispanic ethnicity. However, cancer incidence rates from SEER for Hispanic subgroups are generally not available. To date, several studies have explored cancer incidence and mortality differentials between all Hispanics and White non-Hispanics in Florida [2
]. By drawing no distinction among the different Hispanic subgroups researchers extrapolate data from one Hispanic subgroup to another where this extrapolation may not always be valid and, in fact, may be misleading [20
However, none of these studies has compared all site cancer mortality rates among Cuban, Mexican, Puerto Rican, all other Hispanic and White non-Hispanic racial/ethnic groups in Florida. Our study is the first to disaggregate Florida Hispanic groups and reveal considerable differences in the mortality experience of Florida Hispanics. Specifically, it will provide answers to the following questions: (1) Do cancer mortality rates differ between Cubans, Mexicans, Puerto Ricans and all other Hispanics and (2) How do the cancer mortality rates of each of these Hispanic subgroups compare to those of non-Hispanic Whites?
Given the complexity of these categories, the U.S. Hispanic population serves as an illustrative example to explore heterogeneity found within ethnic groups. Despite shared characteristics (language and relative youth), considerable differences exist among Hispanics, particularly with regard to median age, household size, education and family income [21
]. In Florida, Cubans are the largest Hispanic group (32%) followed by Puerto Ricans (18%), Mexicans (13%), and other Hispanics. During the 1990s, the numbers of immigrants from other Latin American countries increased (Columbians, Dominicans, Nicaraguans), further diversifying the Hispanic population of the state [6
]. In 1993 all states began recording Hispanic ethnicity on death certificates, except for Oklahoma, which began in 1997 [3
]. Despite some studies showing a Hispanic favorable advantage in cancer mortality compared to White non-Hispanics [5
], there is no single source of reliable data on cancer rates, mortality or survival for Hispanic subgroups [25
]. We seek to fill this gap and compare cancer mortality rates across Hispanic subgroups and non-Hispanic Whites.