Asian American/Pacific Islander and Hispanic Ethnic Enclaves, Neighborhood Socioeconomic Status, and Hepatocellular Carcinoma Incidence in California: An Update

Abstract

Background: Using more recent cancer registry data, we analyzed disparities in hepatocellular carcinoma (HCC) incidence by ethnic enclave and neighborhood socioeconomic status (nSES) among Asian American/Pacific Islander (AAPI) and Hispanic populations in California. Methods: Primary, invasive HCC cases were identified from the California Cancer Registry during 1988–1992, 1998–2002, and 2008–2012. Age-adjusted incidence rates (per 100,000 population), incidence rate ratios, and corresponding 95% confidence intervals were calculated for AAPI or Hispanic enclave, nSES, and the joint effects of ethnic enclave and nSES by time period (and the combination of the three periods), sex, and race/ethnicity. Results: In the combined time period, HCC risk increased 25% for highest versus lowest quintile of AAPI enclave among AAPI males. HCC risk increased 22% and 56% for lowest versus highest quintile of nSES among AAPI females and males, respectively. In joint analysis, AAPI males living in low nSES areas irrespective of enclave status were at 17% to 43% increased HCC risk compared with AAPI males living in areas of nonenclave/high nSES. HCC risk increased by 22% for Hispanic females living in areas of low nSES irrespective of enclave status and by 19% for Hispanic males living in areas of nonenclave/low nSES compared with their counterparts living in areas of nonenclave/high nSES. Conclusions: We found significant variation in HCC incidence by ethnic enclave and nSES among AAPI and Hispanic populations in California by sex and time period. Impact: Future studies should explore how specific attributes of enclaves and nSES impact HCC risk for AAPI and Hispanic populations.

Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival

“…Our examination of the association between area deprivation and treatment receipt and timing had mixed results. Previous studies from diverse geographies and racial/ethnic compositions have examined nSES with incident HCC, using various indices to measure the construct ( 11 , 12 , 24 , 25 ). Taken in combination, these studies and ours support the importance of neighborhood context on disparities in HCC incidence, but additional research is needed to clarify potential associations with receipt of treatment.…”

Increasing risk of hepatocellular carcinoma with successive generations in the United States among Mexican American adults: The Multiethnic Cohort

“…In addition, we used residential participant addresses to collect information on their neighborhoods, including nSES and ethnic enclave. Previous studies show that Hispanic adults residing in low‐nSES and either low or high ethnic enclaves have increased HCC risk 5,27 . Neighborhood attributes influence health, 36 so including these variables in our models allowed us to comprehensively adjust for both individual‐level and neighborhood‐level factors.…”

“…Tests for heterogeneity were assessed using the Wald statistic for cross‐product terms of trend variables for BMI, diabetes status, alcohol intake, smoking status, ethnic enclave, and nSES. Ethnic enclave and nSES were transformed to dichotomous variables for heterogeneity tests given the small case counts across quintiles (Q1–Q3, nonenclave; Q4–Q5, enclave; Q1–Q3, low nSES; Q4–Q5, high nSES) 5,27 . A percent change for each unit increase in generational status was calculated as (1 − HR)*100 associated with the test for p for trend.…”

Neighborhood segregation and cancer prevention guideline adherence in US Hispanic/Latino adults: Results from the HCHS/SOL

“…The construct of structural racism is often operationalized as neighborhood racial-ethnic segregation and poverty; and evidence suggest that racial and ethnic segregation is particularly exacerbated by neighborhood poverty ( 14 , 15 ). Segregation is formally measured using five dimensions as developed by Massey and Denton ( 16 ): evenness (the spatial distribution of a group), exposure (the propensity for contact between groups), clustering (groups of interest located in close proximity or neighboring areas), centralization (the extent to which a group resides in or near the center of an urban area), concentration (the relative amount of physical space a group occupies).…”