Colorectal cancer incidence in Asian populations in California: effect of nativity and neighborhood-level factors.
OBJECTIVE
Heritable and environmental factors may contribute to differences in colorectal cancer (CRC) incidence across populations. We capitalized on the resources of the California Cancer Registry (CCR) and California's diverse Asian population to perform a cohort study exploring the relationships between CRC incidence, nativity, and neighborhood-level factors across Asian subgroups.


METHODS
We identified CRC cases in the CCR from 1990 to 2004 and calculated age-adjusted CRC incidence rates for non-Hispanic Whites and US-born vs. foreign-born Asian ethnic subgroups, stratified by neighborhood socioeconomic status (SES) and "ethnic enclave." Trends were studied with joinpoint analysis.


RESULTS
CRC incidence was lowest among foreign-born South Asians (22.0/100,000; 95% confidence interval (CI): 19.7-24.5/100,000) and highest among foreign-born Japanese (74.6/100,000; 95% CI: 70.1-79.2/100,000). Women in all Asian subgroups except Japanese, and men in all Asian subgroups except Japanese and US-born Chinese, had lower CRC incidence than non-Hispanic Whites. Among Chinese men and Filipino women and men, CRC incidence was lower among foreign-born than US-born persons; the opposite was observed for Japanese women and men. Among non-Hispanic Whites, but not most Asian subgroups, CRC incidence decreased over time. CRC incidence was inversely associated with neighborhood SES among non-Hispanic Whites, and level of ethnic enclave among Asians.


CONCLUSIONS
CRC incidence rates differ substantially across Asian subgroups in California. The significant associations between CRC incidence and nativity and residence in an ethnic enclave suggest a substantial effect of acquired environmental factors. The absence of declines in CRC incidence rates among most Asians during our study period may point to disparities in screening compared with Whites.
1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Uri
U
Ladabaum
1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] Cancer Prevention Institute of California, Fremont, California, USA.
Christina A
CA
Clarke
Cancer Prevention Institute of California, Fremont, California, USA.
David J
DJ
Press
1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Ajitha
A
Mannalithara
1] Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA [2] Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Parvathi A
PA
Myer
Cancer Prevention Institute of California, Fremont, California, USA.
Iona
I
Cheng
1] Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA [2] Cancer Prevention Institute of California, Fremont, California, USA.
Scarlett Lin
SL
Gomez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D002140:California / Q000453:epidemiology; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000191:economics / Q000208:ethnology* / Q000209:etiology; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010679:Philippines / Q000208:ethnology; D012044:Regression Analysis; D012111:Residence Characteristics; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class; D044465:White People