title: How do social factors explain outcomes in non-small-cell lung cancer among Hispanics in California? Explaining the Hispanic paradox.
abstract: OBJECTIVE
  Hispanics in the United States have lower age-adjusted mortality resulting from non-small-cell lung cancer (NSCLC) compared with non-Hispanic whites (NHWs). The purpose of this study was to evaluate individual, clinical, and neighborhood factors in survival among Hispanics with NSCLC.
  
  
  METHODS
  We performed a retrospective analysis of NHWs and Hispanics with NSCLC between 1998 and 2007 in the California Cancer Registry (follow-up to December 2009). Kaplan-Meier curves depict survival by nativity for Hispanics with NSCLC. Cox proportional hazards models estimated hazard of mortality by race with adjustment for individual (age, sex, marital status), clinical (histologic grade, surgery, irradiation, chemotherapy), and neighborhood factors (neighborhood socioeconomic status, ethnic enclave).
  
  
  RESULTS
  We included 14,280 Hispanic patients with NSCLC. Foreign-born Hispanics had 15% decreased risk of disease-specific mortality resulting from NSCLC compared with NHWs (hazard ratio [HR], 0.85; 95% CI, 0.83 to 0.88) after adjustment for individual, clinical, and neighborhood factors. After adjustment for individual factors, compared with US-born Hispanics, foreign-born Hispanics had 10% decreased risk of disease-specific mortality (HR, 0.90; 95% CI, 0.87 to 0.96). Clinical and neighborhood factors slightly moderated the survival benefit for foreign-born patients. A modestly more pronounced survival advantage was seen for foreign-born Hispanics living in low socioeconomic and high Hispanic enclave neighborhoods as compared with US-born Hispanics (HR, 0.86; 95% CI, 0.81 to 0.90).
  
  
  CONCLUSIONS
  Foreign-born Hispanics with NSCLC have a decreased risk of disease-specific mortality compared with NHWs and US-born Hispanics with NSCLC. Neighborhood factors slightly moderate this survival advantage. This survival advantage is slightly more pronounced in lower socioeconomic and higher Hispanic enclave neighborhoods.
authors: Manali I. Patel, Scarlett L. Gomez, Ellen T. Chang, and Heather A. Wakelee, Stanford University; Scarlett L. Gomez and Heather A. Wakelee, Stanford Cancer Institute, Stanford; Clayton W. Schupp and Scarlett L. Gomez, Cancer Prevention Institute of California, Fremont; and Ellen T. Chang, Exponent Health Sciences Practices, Menlo Park, CA.
authors: Manali I
authors: MI
authors: Patel
authors: Clayton W
authors: CW
authors: Schupp
authors: Scarlett L
authors: SL
authors: Gomez
authors: Ellen T
authors: ET
authors: Chang
authors: Heather A
authors: HA
authors: Wakelee
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D000368:Aged; D002140:California; D018287:Carcinoma, Large Cell / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data
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