title: Socioeconomic deprivation as a determinant of cancer mortality and the Hispanic paradox in Texas, USA.
abstract: BACKGROUND
  We have recently reported that delayed cancer detection is associated with the Wellbeing Index (WI) for socioeconomic deprivation, lack of health insurance, physician shortage, and Hispanic ethnicity. The current study investigates whether these factors are determinants of cancer mortality in Texas, the United States of America (USA).
  
  
  METHODS
  Data for breast, colorectal, female genital system, lung, prostate, and all-type cancers are obtained from the Texas Cancer Registry. A weighted regression model for non-Hispanic whites, Hispanics, and African Americans is used with age-adjusted mortality (2004-2008 data combined) for each county as the dependent variable while independent variables include WI, percentage of the uninsured, and physician supply.
  
  
  RESULTS
  Higher mortality for breast, female genital system, lung, and all-type cancers is associated with higher WI among non-Hispanic whites and/or African Americans but with lower WI in Hispanics after adjusting for physician supply and percentage of the uninsured. Mortality for all the cancers studied is in the following order from high to low: African Americans, non-Hispanic whites, and Hispanics. Lung cancer mortality is particularly low in Hispanics, which is only 35% of African Americans' mortality and 40% of non-Hispanic whites' mortality.
  
  
  CONCLUSIONS
  Higher degree of socioeconomic deprivation is associated with higher mortality of several cancers among non-Hispanic whites and African Americans, but with lower mortality among Hispanics in Texas. Also, mortality rates of all these cancers studied are the lowest in Hispanics. Further investigations are needed to better understand the mechanisms of the Hispanic Paradox.
authors.affiliation: F. Marie Hall Institute for Rural and Community Health, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA. billy.philips@ttuhsc.edu
authors.forename: Billy U
authors.initials: BU
authors.lastname: Philips
authors.forename: Eric
authors.initials: E
authors.lastname: Belasco
authors.forename: Kyriakos S
authors.initials: KS
authors.lastname: Markides
authors.forename: Gordon
authors.initials: G
authors.lastname: Gong
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology* / Q000401:mortality*; D010820:Physicians / Q000600:supply & distribution; D016012:Poisson Distribution; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult