In 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.
We 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.
Compared 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.
Identifying the modifiable factors that facilitate this survival advantage in Hispanic immigrants could help to inform specific interventions to improve survival in this growing population.
We estimated trends in breast cancer incidence rates for specific Asian populations in California to determine if disparities exist by immigrant status and age.
To calculate rates by ethnicity and immigrant status, we obtained data for 1998 through 2004 cancer diagnoses from the California Cancer Registry and imputed immigrant status from Social Security Numbers for the 26% of cases with missing birthplace information. Population estimates were obtained from the 1990 and 2000 US Censuses.
Breast cancer rates were higher among US- than among foreign-born Chinese (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] = 1.72, 1.96) and Filipina women (IRR = 1.32; 95% CI=1.20, 1.44), but similar between US- and foreign-born Japanese women. US-born Chinese and Filipina women who were younger than 55 years had higher rates than did White women of the same age. Rates increased over time in most groups, as high as 4% per year among foreign-born Korean and US-born Filipina women. From 2000–2004, the rate among US-born Filipina women exceeded that of White women.
These findings challenge the notion that breast cancer rates are uniformly low across Asians and therefore suggest a need for increased awareness, targeted cancer control, and research to better understand underlying factors.
The objective of this study was to characterize better the cancer burden among Asian subgroups in California. Nearly 3.7 million Asians reside in California, and no other state has as many Asians. Cancer statistics for Asians often are combined with statistics for Pacific Islanders, and rates for subgroups are not often examined, because most states do not have a large enough population. Asians are affected disproportionately by certain cancers, such as stomach and liver cancers. The California Cancer Registry, a population-based cancer registry, has collected data, including race/ethnicity data, since 1988. The 5-year, average, annual, age-adjusted cancer incidence and mortality rates from 1997 through 2001 were calculated for 5 Asian subgroups: Chinese, Filipino, Japanese, Korean, and Vietnamese. Cancer incidence and mortality varied greatly. Incidence rates for all sites combined among males varied from a low of 318.6 per 100,000 for Chinese to a high of 366.0 per 100,000 among Japanese. For females, rates ranged from 236.6 per 100,000 among Koreans to 302.4 per 100,000 among Japanese. Mortality rates also varied by Asian subgroup. Presenting one statistic for Asian/Pacific Islanders did not provide an accurate depiction of the cancer burden among the different Asian subgroups. Acculturation will continue to affect the patterns of cancer incidence among Asian subgroups in California.
Asian American Network for Cancer Awareness, Research, and Training; cancer surveillance; Chinese; incidence; mortality; Filipino; Japanese; Korean; Vietnamese; California
Using combined data from the population-based 2001 and 2003 California Health Interview Surveys, we examined ethnic and gender-specific smoking behaviors and the effect of three acculturation indicators on cigarette smoking behavior and quitting status among 8,192 Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese American men and women. After adjustment for potential confounders, current smoking prevalence was higher and the quit rate was lower for Korean, Filipino, and Vietnamese American men compared with Chinese American men. Women’s current smoking prevalence was lower than men’s in all six Asian American subgroups. South Asian and Korean American women reported lower quit rates than women from other ethnic subgroups. Asian American men who reported using only English at home had lower current smoking prevalence and higher quit rates, except for Filipino and South Asian American men. Asian American women who reported using only English at home had higher current smoking prevalence except for Japanese women. Being a second or later generation immigrant was associated with lower smoking prevalence among all Asian American subgroups of men. Less educated men and women had higher smoking prevalence and lower quit rates. In conclusion, both current smoking prevalence and quit rates vary distinctively across gender and ethnic subgroups among Asian Americans in California. Acculturation appears to increase the risk of cigarette smoking for Asian American women. Future tobacco-control programs should target at high-risk Asian American subgroups, defined by ethnicity, acculturation status, and gender.
Asians and Hispanics have the highest incidence rates of liver cancer in the US, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring.
Incidence rates and rate ratios (IRRs) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988–2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 US Census data for cases diagnosed in 1998–2002.
Foreign-born Hispanic males had significantly lower liver cancer incidence rates than US-born Hispanic males in 1988–2004 (e.g., IRR=0.54, 95% confidence interval [CI]=0.50–0.59), whereas foreign-born Hispanic females had significantly higher rates in 1988–1996 (IRR=1.42, 95% CI=1.18–1.71), but not 1997–2004. Foreign-born Asian males and females had up to 5-fold higher rates than the US-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates.
Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention.
Liver cancer control efforts should especially target foreign-born Asians, US-born Hispanic men, and residents of lower-SES ethnic enclaves.
Given the low prevalence of and racial/ethnic disparities in colorectal cancer (CRC) screening, it is important to monitor whether prevalence and disparities are increasing or decreasing over time.
We estimated the prevalence of CRC screening by year (2001, 2003 and 2005), modality (endoscopy, fecal occult blood test, either) and recency (ever had, up-to-date) for the California population as a whole, major racial/ethnic groups (White, Black, Latino, Asian), and selected Asian subgroups (Chinese, Filipino, Japanese, Korean, Vietnamese) using data from the California Health Interview Survey. All prevalence estimates were age- and gender-standardized.
Between 2001 and 2005, prevalence of up-to-date screening increased significantly among Whites and Latinos but not among Blacks and Asian Americans. Screening prevalence varied substantially among Asian subgroups, with Korean, Filipino and Vietnamese Americans having the lowest prevalence. Korean Americans were the only group in the analysis with a significant decline in screening prevalence between 2001 and 2005. The gap between the highest and lowest up-to-date screening prevalence using any screening modality, exhibited by Japanese and Korean Americans, increased from 18% in 2001 to 30% in 2005.
Findings suggest that we need to intensify efforts to increase colorectal cancer screening, especially among Korean Americans but also among Filipinos, Vietnamese and Latinos.
colorectal cancer screening; ethnic disparities; Asian subgroups; California Health Interview Survey
Binge drinking (five drinks or more in a 2-hour sitting for men, or four or more drinks in a 2-hour sitting for women) and alcohol-related problems are a growing problem among Asian American young adults. The current study examines the socio-cultural (i.e., generational status and ethnic identity) determinants of binge drinking and alcohol-related problems across U.S.-born, young adult, Asian American ethnic groups. Data were collected from 1,575 Asian American undergraduates from a public university in Southern California. Chinese Americans consisted of the largest Asian ethnicity in the study followed by Vietnamese, Filipino, Korean, South Asian, Japanese, Multi-Asian, and “other Asian American”. Participants completed a web-based assessment of binge drinking, alcohol-related problems, ethnic identity, descriptive norms (i.e., perceived peer drinking norms) and demographic information. An analysis of variance was used to determine potential gender and ethnic differences in binge drinking and alcohol-related problems. Negative binomial regression was selected to examine the relationship between the predictors and outcomes in our model. There were no gender differences between Asian American men and women in regards to binge drinking, however men reported more alcohol-related problems. Japanese Americans reported the highest number of binge drinking episodes and alcohol-related problems, followed by Filipino, and Multi-Asian Americans (e.g., Chinese and Korean). Living off-campus, higher scores in descriptive norms, Greek status, and belonging to the ethnic groups Japanese, Filipino, Multi-Asian, Korean, and South Asian increased the risk of engaging in binge drinking. Quantity of alcohol consumed, Greek status, gender, Filipino, South Asian “Other” Asian, and lower ethnic identity scores were related to alcohol-related problems. Using one of the largest samples collected to date on socio-cultural determinants and drinking among U.S.-born Asian American young adults, the findings highlight the significant variability in drinking patterns between Asian American ethnic groups.
Asian Americans; U.S-Born; binge drinking; alcohol-related problems
Mortality after breast cancer diagnosis is known to vary by race/ethnicity even after adjustment for differences in tumor characteristics. As adjuvant hormonal therapy decreases risk of recurrence and increases overall survival among women with hormone receptor-positive tumors, treatment disparities may play a role. We explored racial/ethnic differences in initiation of adjuvant hormonal therapy, defined as 2 or more prescriptions for tamoxifen or aromatase inhibitor filled within the first year after diagnosis of hormone receptor-positive localized or regional stage breast cancer. The sample included women diagnosed with breast cancer enrolled in Kaiser Permanente Northern California (KPNC).
Odds ratios [OR] and 95% confidence intervals [CI] compared initiation by race/ethnicity (Hispanic, African American, Chinese, Japanese, Filipino, and South Asian vs. non-Hispanic White (NHW)) using logistic regression. Covariates included age and year of diagnosis, area-level socioeconomic status, co-morbidities, tumor stage, histology, grade, breast cancer surgery, radiation and chemotherapy use.
Our sample included 13,753 women aged 20–79 years, diagnosed between 1996 and 2007, and 70% initiated adjuvant hormonal therapy. In multivariable analysis, Hispanic and Chinese women were less likely than NHW women to initiate adjuvant hormonal therapy ([OR]=0.82; [CI] 0.71–0.96 and [OR]=0.78; [CI] 0.63–0.98; respectively).
Within an equal access, insured population, lower levels of initiation of adjuvant hormonal therapy were found for Hispanic and Chinese women. Findings need to be confirmed in other populations and the reasons for under-initiation among these groups need to be explored.
breast cancer; adjuvant hormonal therapy; tamoxifen; aromatase inhibitors; racial/ethnic disparities
Among Asian Americans, colorectal cancer (CRC) is the second most commonly diagnosed cancer, and it is the third highest cause of cancer-related mortality. The 2001 California Health Interview Survey (CHIS 2001) was used to examine 1) CRC screening rates between different Asian-American ethnic groups compared with non-Latino whites and 2) factors related to CRC screening. The CHIS 2001 was a population-based telephone survey that was conducted in California. Responses about CRC screening were analyzed from 1771 Asian Americans age 50 years and older (Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese). The authors examined two CRC screening outcomes: individuals who ever had CRC screening and individuals who were up to date for CRC screening. For CRC screening, fecal occult blood test (FOBT), sigmoidoscopy/colonoscopy, and any other form of screening were examined. CRC screening of any kind was low in all populations, and Koreans had the lowest rate (49%). Multivariate analysis revealed that, compared with non-Latino whites, Koreans were less likely to undergo FOBT (odds ratio [OR], 0.40; 95% confidence interval [95% CI], 0.25–0.62), and Filipinos were the least likely to undergo sigmoidoscopy/colonoscopy (OR, 0.62; 95% CI, 0.44–0.88) or to be up to date with screening (OR, 0.68; 95% CI, 0.48–0.97). Asian Americans were less likely to undergo screening if they were older, male, less educated, recent immigrants, living with ≥ 3 individuals, poor, or uninsured. Asian-American populations, especially Koreans and Filipinos, are under-screened for CRC. Outreach efforts could be more focused on helping Asian Americans to understand the importance of CRC screening, providing accurate information in different Asian languages. Other strategies for increasing CRC screening may include using a more family-centered approach and using qualified translators.
Asian American Network for Cancer Awareness, Research, and Training; cancer; Chinese; Vietnamese; Korean; Filipino; South Asian; Japanese; fecal occult blood test; sigmoidoscopy; colonoscopy
Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened.
To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined.
We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married.
We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.
To investigate how birthplace influences the incidence of papillary thyroid cancer among Asian American women.
Birthplace- and ethnic-specific age-adjusted and age-specific incidence rates were calculated using data from the California Cancer Registry for the period 1988–2004. Birthplace was statistically imputed for 30% of cases using a validated imputation method based on age at Social Security number issuance. Population estimates were obtained from the US Census. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated for foreign-born vs. US-born women.
Age-adjusted incidence rates of papillary thyroid cancer among Filipina (13.7 per 100,000) and Vietnamese (12.7) women were more than double those of Japanese women (6.2). US-born Chinese (IRR=0.48, 95% CI: 0.40–0.59) and Filipina women (IRR=0.74, 95% CI: 0.58–0.96) had significantly higher rates than those who were foreign-born; the opposite was observed for Japanese women (IRR=1.55, 95% CI: 1.17–2.08). The age-specific patterns among all foreign-born Asian women and US-born Japanese women showed a slow steady increase in incidence until age 70. However, among US-born Asian women (except Japanese), substantially elevated incidence rates during the reproductive and menopausal years were evident.
Ethnic- and birthplace-variation in papillary thyroid cancer incidence can provide insight into the etiology of this increasingly common and understudied cancer.
papillary thyroid cancer; incidence rates; birthplace; Asian American women; cancer surveillance
Breast cancer incidence is higher in US-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants).
Information regarding all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 were obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data.
From 1988 to 2004, incidence rates for US-born Hispanics were parallel, but lower than, those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for US- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women > 50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES.
Compared to foreign-born, US-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflects these differences in risk factors.
Further research is needed to separate the effects of individual- and neighborhood-level factors that impact incidence in this large and growing population.
The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females.
public health; epidemiology; cancer; statistics
Asian Americans represent a mix of cultures and immigration experiences, which may put them differentially at risk for mental health problems. Yet, little is known about the mental health needs of older adults from various Asian subgroups compared to non-Hispanic whites.
To compare the prevalence rates of mental distress of Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese older adults (aged 55 and older) to that of non-Hispanic whites; and to examine subgroup differences in utilization of mental health services.
A cross-sectional analysis of a population-based sample of California adults responding to the 2007 California Health Interview Survey. Multivariable logistic regression analysis was used to examine subgroup differences in mental health status and use of mental health services among the six different Asian subgroups and non-Hispanic whites, adjusting for respondents’ demographic and health characteristics, socioeconomic status, and English-language proficiency.
A total of 20,712 respondents were included. Filipino [aOR=2.25; 95% CI=1.14-4.47] and Korean Americans [aOR=2.10; 95% CI=1.06-4.17] were more likely to report symptoms indicative of mental distress compared to non-Hispanic whites, yet were less likely to have seen a primary care provider [Filipino: aOR=0.41; 95% CI=0.18-0.90; Korean: aOR=0.24; 95% CI = 0.08-0.69] or have taken a prescription medication [Filipino: aOR=0.20; 95% CI=0.10-0.40; Korean: aOR=0.15; 95% CI=0.05-0.40], even after adjusting for indicators of respondents’ demographic and health characteristics, socioeconomic status, and English-language proficiency. In contrast, Japanese Americans were less likely to report symptoms indicative of mental distress [aOR=0.43; 95% CI=0.21-0.90], and were less likely to make use of mental health services compared to non-Hispanic whites.
The findings from this study not only highlight the unmet mental health needs among older Asian Americans, but also illustrate significant variations among the various Asian subgroups. Clinicians who work closely with these patients should regularly screen and assess older Asian adults for symptoms related to their mental health needs.
Asian Americans; mental health; aging; distress; California Health Interview Survey (CHIS)
We report upper and lower boundary estimates of the 1999–2001 site-specific cancer mortality rates for Asian Indians, Chinese, Filipinos, Koreans, Vietnamese, Native Hawaiians, and Samoans. These rates are for the seven states (California, Hawaii, Illinois, New Jersey, New York, Texas, and Washington) that officially record mortality data for these ethnicities. The rates are based on the 2000 Census, which reports two population counts as follows: persons who identify themselves as belonging to a single ethnic group (which forms the basis for an upper boundary estimate of the rates) and persons who identify themselves as belonging to a single ethnic group or to multiple groups that include the single ethnic group (which forms the basis for a lower boundary estimate for the rates). The top five cancers for each Asian and Pacific Islander ethnic group by gender are reported. In addition, the 1988–1992 cancer mortality rates based on the 1990 Census for Chinese, Filipino, Japanese, and Native Hawaiians are determined. Their 1999–2001 and 1988–1992 rates are compared.
AANCART; Asian American; cancer; Pacific Islander; cancer mortality
To establish baseline data for lymphoid neoplasm incidence by subtype for six Asian-American ethnic groups.
Incident rates were estimated by age and sex for six Asian ethnic groups—Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese— in five United States cancer registry areas during 1996–2004. For comparison, rates for non-Hispanic Whites were also estimated.
During 1996–2004, Filipinos had the highest (24.0) and Koreans had the lowest incidence (12.7) of total lymphoid neoplasms. By subtype, Vietnamese and Filipinos had the highest incidence for diffuse large B-cell lymphoma (DLBCL) (8.0 and 7.2); Japanese had the highest incidence of follicular lymphoma (2.3). Although a general male predominance of lymphoid neoplasms was observed, this pattern varied by lymphoid neoplasm subtype. Whites generally had higher rates than all Asian ethnic groups for all lymphoid neoplasms and most lymphoma subtypes, although the magnitude of the difference varied by both ethnicity and lymphoma subtype.
The observed variations in incidence patterns among Asian ethnic groups in the United States suggest that it may be fruitful to pursue studies that compare Asian populations for postulated environmental and genetic risk factors.
Lymphoid neoplasms; Asians
Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHLs), Hodgkin lymphoma (HL) and multiple myeloma (MM), occur at much lower rates in Asians than other racial/ethnic groups in the United States (US). It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status.
We obtained data regarding all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from US Census data.
While incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than US-born Asians, with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower-SES neighborhoods than those living elsewhere. Conclusions: These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL.
Studying specific lymphoid malignancies in US Asians may provide valuable insight towards understanding their environmental causes.
lymphoid malignancies; Asians; immigration; environmental causes
Hepatocellular carcinoma (HCC) represents a significant health disparity affecting Asian Americans, a population comprised of distinct ethnic groups. The purpose of this paper is to analyze Californians of Asian ancestry with HCC with respect to socioeconomic status, demographic factors, stage of disease, treatment received, and survival.
To investigate ethnic differences in survival, we analyzed ethnically disaggregated data from 6068 Californians of Asian ancestry with hepatocellular carcinoma (HCC) diagnosed in 1988–2007 and reported to the California Cancer Registry.
Compared to the average of all ethnic groups, cause-specific mortality was significantly higher among Laotian/Hmong (hazard ratio (HR) =2.08, 95% confidence interval (CI) 1.78–2.44) and Cambodian patients (HR=1.26, 95% CI 1.06–1.51), groups with higher proportions of their populations at low levels of socio-economic status; in addition, Laotian/Hmong patients disproportionately presented at later stages of disease, with only 3% receiving local surgical treatment, resection, or liver transplantation.
After adjustment for time period of diagnosis, age at diagnosis, gender, geographic region, stage at diagnosis, type of surgery, and socio-economic status, survival disparities remained for both groups (Laotian/Hmong: HR=1.51, 95% CI 1.28–1.79; and Cambodian: HR=1.23, 95% CI 1.05–1.44).
Our hypothesis that survival outcomes would differ by ethnicity was verified.
Research is needed not only to develop more effective treatments for HCC, but also to develop community-based interventions to recruit Asian Americans, particularly Laotian/Hmong and Cambodians, for hepatitis B screening and into medical management to prevent or detect this tumor at an early stage.
hepatocellular carcinoma; Asian Americans
Many clinical data sources used to assess health disparities lack Asian subgroup information, but do include patient names.
This project validates Asian surname and given name lists for identifying Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) in clinical records.
We used 205,000 electronic medical records from the Palo Alto Medical Foundation, a multipayer, outpatient healthcare organization in Northern California, containing patient self-identified race/ethnicity information.
Name lists were used to infer racial/ethnic subgroup for patients with self-identified race/ethnicity data. Using self-identification as the “gold standard,” sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of classification by name were calculated. Clinical outcomes (obesity and hypertension) were compared for name-identified versus self-identified racial/ethnic groups.
With classification using surname and given name, the overall sensitivities ranged from 0.45 to 0.76 for the 6 racial/ethnic groups when no race data are available, and 0.40 to 0.79 when the broad racial classification of “Asian” is known. Specificities ranged from 0.99 to 1.00. PPV and NPV depended on the prevalence of Asians in the population. The lists performed better for men than women and better for persons aged 65 and older. Clinical outcomes were very similar for name-identified and self-identified racial/ethnic groups.
In a clinical setting with a high prevalence of Asian Americans, name-identified and self-identified racial/ethnic groups had similar clinical characteristics. Asian name lists may be a valid substitute for identifying Asian subgroups when self-identification is unavailable.
Asian race/ethnicity; surname analysis; racial disparities
We examined how different dimensions of social capital (i.e., family and friend connections, neighborhood and family cohesion, family conflict) were associated with smoking behavior among a nationally representative sample of Asian American men and whether the associations varied by ethnic group.
The sample consisted of 998 adult Asian American men who participated in the National Latino and Asian American Survey from 2002 to 2003. We conducted weighted multivariate logistic regressions on data for the sample and for each of 4 ethnic subgroups (Chinese, Vietnamese, Filipino, and Other).
Vietnamese American men had the highest prevalence of current smoking; Chinese American men, the lowest. After controlling for sociodemographics, socioeconomic status, acculturation, and perceived discrimination, neighborhood cohesion was inversely associated with smoking among Asian American men, and family and friend connections and family cohesion were not. An exception was family cohesion, which was associated with increased odds of smoking among Filipino American men.
The relationship between social capital and smoking among Asian American men varied according to specific dimensions of social capital and was ethnicity specific. These findings highlight the need for smoking prevention and cessation interventions to take into consideration the heterogeneity that exists among Asian Americans.
To obtain information about newborn health outcomes among nine subgroups of the Asian population in the United States.
Cross-sectional comparison of outcomes for births to Cambodian-, Chinese-, Filipino-, Indian-, Japanese-, Korean-, Laotian-, Thai-, and Vietnamese-origin mothers, and births to non-Hispanic white mothers. Regression models are used to compare neonatal mortality rates across groups, before and after controlling for a range of risk factors.
All California births between 1991 and 2001
Racial and ethnic groups
Neonatal mortality (death within 28 days of birth)
Unadjusted mortality rates in some Asian-American subgroups are significantly different from rates for non-Hispanic whites (non-Hispanic white rate=2.0 per 1,000 births; Chinese=1.2, Japanese=1.2, Korean=2.7; all p<0.05). For infants of Chinese mothers, observed risk factors explain the differences observed in unadjusted data. For Cambodian, Japanese, Korean, and Thai newborns, differences persist or even widen after risk factors are taken into account. After risk adjustment, infants of Cambodian, Japanese, and Korean mothers have significantly lower neonatal mortality rates than those born to non-Hispanic whites (adjusted OR=0.58 for Cambodian, 0.67 for Japanese, 0.69 for Korean, all p<0.05), and infants of Thai mothers have higher rates (adjusted OR 1.89, p<0.05).
There are significant variations in neonatal mortality between subgroups of the Asian-American population that are not entirely explained by differences in observable risk factors. Efforts to improve clinical care that treat Asian-Americans as a homogeneous group may miss important opportunities for improving infant health in specific sub-groups.
South Asians from India and Pakistan represent one of the fastest growing immigrant populations in the US, yet there are limited data assessing breast cancers for this distinct ethnic sub-group. The aim of this study was to analyze clinical-pathologic, treatment and outcome characteristics of U.S.-residing Indian-Pakistani (IP) versus non-Hispanic white (NHW) female breast cancer patients to assess if any differences/disparities exist. The study cohort consisted of 2,393 IP and 555,832 NHW women (diagnosed 1988–2006) in the SEER database. Differences between the two populations were analyzed using chisquared and multivariate regression analysis. Age-adjusted incidence, mortality, and relative survival rates were calculated for the two groups. Significant differences in the characteristics of the IP cohort’s invasive disease included: younger median age at presentation; larger tumor size; higher stage, higher grade, more involved lymph-nodes, and more hormone receptor negative disease (all P < 0.01). The age-adjusted incidence and breast cancer mortality were lower in IP women. The relative survival at 5 years was statistically significant at 84% for IP versus 89% for NHW women, but was not significantly different on multivariate analysis (P > 0.05). Within each stage (Tis, I, II), there were no disparities in the rate of breast conservation surgery (BCS) or in the percentage of patients receiving adjuvant radiation after BCS for the 2 cohorts. Post-mastectomy radiation was delivered significantly more often in stage I/II IP patients undergoing mastectomy. In conclusion, this analysis suggests that while there appear to be significant differences in the features of breast cancers of US-residing IP women, no disparities were noted in the rates of breast conserving surgery or adjuvant radiation, as seen in some other ethnicities. The more aggressive clinical-pathologic features stage-for-stage in IP women may partially explain the more frequent use of post-mastectomy RT in this patient population. These findings warrant further investigation.
Breast cancer; Ethnicity Indian; Disparities; SEER Radiation; Pakistan; Breast conservation; Asian
Prevalence of hepatitis B among Asian Americans is higher than for any other ethnic group in the United States. Since more than 50% of liver cancer is hepatitis B related, the burden of morbidity and mortality is extremely high among Asian Americans, highlighting the need for culturally appropriate interventions. We conducted focus groups (n = 8) with a total of 58 Korean, Vietnamese, and Chinese immigrants in Maryland to explore knowledge, awareness and perceived barriers toward hepatitis B screening and vaccinations. Thematic analysis uncovered generally low levels of knowledge and awareness of hepatitis B risks, screening, and vaccination; inter-generational differences; and barriers to prevention. Some differences arose across ethnic groups, particularly toward perceived orientation to preventive activities and the role of religious groups. High rates of hepatitis B infection among Asian Americans highlight the need for tailored interventions. These findings may assist policy strategists in implementing interventions that will facilitate the integration and scale-up of hepatitis B education, screening, and vaccination campaigns.
Hepatitis B risk; HBV screening and vaccinations; Asian Americans; Qualitative; Immigrant health
Asian subgroup-specific information on type 2 diabetes mellitus (DM) is scarce. Using the California Health Interview Survey 2007 data, we examined Chinese, Korean, Japanese, Filipinos, and Vietnamese adults (n = 3,688) and Caucasian adults (n = 33,981) for the prevalence of DM and risk factors. The age-adjusted prevalence of DM was the highest among Filipinos (8.05%) followed by Japanese (7.07%), Vietnamese (7.03%), and Koreans (6.3%). Chinese (5.93%) was the only Asian group studied whose prevalence was lower than Caucasians (5.94%). From multiple logistic regression, after adjusting for risk factors, Japanese had the highest likelihood of DM (OR = 1.75, CI = [1.12–2.73], P < 0.05), followed by Filipinos (1.66, [1.13–2.43], P < 0.01), and Koreans (1.59, [1.00–2.52], P < 0.05), relative to Caucasians. Our results suggest that even after accounting for lifestyle and other risk factor differences between Caucasians and key Asian subgroups in California, Japanese, Filipinos, and Koreans have a 1.6–1.75 greater likelihood of DM compared to Caucasians.
Asians; Type 2 diabetes; Surveys; Epidemiology
Breast cancer incidence and mortality have been increasing among American Indian and Alaska Native (AI/AN) women, and their survival rate is the lowest of all racial/ethnic groups. Nevertheless, knowledge of AI/AN women’s breast cancer screening practices and their correlates is limited.
Using the 2003 California Health Interview Survey, we 1) compared the breast cancer screening practices of AI/AN women to other groups and 2) explored the association of several factors known or thought to influence AI/AN women’s breast cancer screening practices.
Compared to other races, AI/AN women had the lowest rate of mammogram screening (ever and within the past 2 years). For clinical breast exam receipt, Asian women had the lowest rate, followed by AI/AN women. Factors associated with AI/AN women’s breast cancer screening practices included older age, having a high school diploma or some college education, receipt of a Pap test within the past 3 years, and having visited a doctor within the past year.
Significant differences in breast cancer screening practices were noted between races, with AI/AN women often having significantly lower rates. Integrating these epidemiological findings into effective policy and practice requires additional applied research initiatives.
breast cancer screening; American Indian or Alaska Native; women’s health