title: Cancer survival among Latinos and the Hispanic Paradox.
abstract: BACKGROUND
  Cancer survival is a key indicator of the effectiveness and social justice of health services. However, little is known about cancer survival among Hispanics, how it varies by Hispanic subgroup (Mexicans, Puerto Ricans, Cubans, and Others), and how their survival patterns relate to the Hispanic Paradox.
  
  
  METHODS
  We studied all 1.2 million cancer cases diagnosed during 1995-2003, in two states, Florida and Texas, according to three categories of outcome: highly fatal outcome, poor outcome, and moderate outcome. All were followed up until December 31, 2006. We calculated survival rates for each Hispanic subgroup, and using Cox regression, we studied the risk of death for each Hispanic subgroup compared with non-Hispanic Whites, adjusted for age, cancer site, and stage at diagnosis.
  
  
  RESULTS
  Important differences in cancer survival were found according to Hispanic subgroup. For cancers of moderate outcome, the adjusted risk of death was higher among all Hispanic populations in comparison with non-Hispanic Whites: 6% higher for Cubans, 11% for Puerto Ricans, and 13% for US-born Mexicans. Foreign-born Mexicans, even with incomplete follow-up, had a 24% higher risk of death. For foreign-born Hispanics, except Cubans, the mortality follow-up of cancers of highly fatal outcome was insufficient, resulting in missing deaths and thus unrealistically high survival rates.
  
  
  CONCLUSIONS
  No evidence of a Hispanic advantage was found in cancer survival. Improvement in mortality follow-up procedures for Latinos, especially for those without a valid social security number, is critical. By considering Hispanics as a whole rather than by subgroup, existing survival disparities are being missed.
authors.affiliation: School of Community Health Sciences, University of Nevada Las Vegas, BHS 359, S Maryland Parkway, Box 490693, Las Vegas, NV 89154, USA. paulo.pinheiro@unlv.edu
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Pinheiro
authors.forename: Melanie
authors.initials: M
authors.lastname: Williams
authors.forename: Eric A
authors.initials: EA
authors.lastname: Miller
authors.forename: Stephanie
authors.initials: S
authors.lastname: Easterday
authors.forename: Sheniz
authors.initials: S
authors.lastname: Moonie
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Trapido
mesh_terms: D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality*; D015996:Survival Rate