Ethnicity and Nativity in Cancer - Latino & Asian Enclaves: The ENCLAVE Study

项目摘要/摘要 癌症是拉美裔和亚裔美国人的主要死因，他们是增长最快的群体之一 美国的人口很大一部分拉美裔和亚裔美国人生活在种族飞地上--截然不同 具有高度集中的同一种族血统的个人(“同族居民”)的社区 同样以最近的移民和语言孤立为特征。现有的文献是混合的，有一些 研究表明，民族飞地居住地(与非飞地居住地相比)和外国(与美国相比)出生地 与整个癌症连续体的更好和/或更差的结果有关。在这项研究中，我们将汇集 五个州(加州、佛罗里达州、新泽西州、纽约州、德克萨斯州)的癌症登记数据，其中大部分是拉丁裔和亚裔 并将这些数据与表征社会、建筑和医疗保健的背景数据联系起来 环境。我们将确定民族飞地居住地和外国出生地是否以及如何 与三种癌症结果(发病率、诊断阶段、生存时间)有关的患者中有九人 最大的拉丁裔和亚洲族裔(古巴人、墨西哥人、波多黎各人、中国人、菲律宾人、日本人、韩国人 南亚人、越南人)被诊断患有三种癌症(乳腺癌、宫颈癌和结直肠癌)。 具体地说，我们的目标是定义和描述种族飞地，并按飞地检查癌症发病率。 居住(目标1)，并确定族裔飞地居住地和出生地的独立和联合联系 (外国对美国出生地)在诊断阶段(目标2)以及死亡率(目标3)。有20多万人 拉丁裔和亚裔美国人的乳腺癌、结直肠癌和宫颈癌病例，我们将使用多水平模型来 了解种族飞地对这些未被研究的人群的癌症结局的影响。在此过程中， 我们的研究将加速发现社区、种族、出生地和 并将改进全美癌症登记中心使用的数据和方法。 为发展多级干预措施提供信息的潜力，以利用促进健康的飞地属性 并消除任何障碍，缩小差距，改善我们增长最快的少数民族的结果 和移民社区。我们将传播我们的飞地措施和失踪的赔偿程序 数据提供给北美中央癌症登记协会(NAACCR)。在此过程中，我们的方法将 提高癌症登记数据的完整性，用于监测不断增长的拉丁裔和亚裔美国人 人口。我们的传播计划与全国有色人种协进会领导层以及 五个州的NCI指定癌症中心的社区外联和参与将确保1) 方法很容易被全国的癌症登记和健康差异研究人员采用；以及2) 研究结果为社区参与解决拉丁裔和亚裔之间多水平癌症差异的努力提供了依据 人口。

Project Summary/Abstract Cancer is the leading cause of death for Latinos and Asian Americans, who are among the fastest growing populations in the U.S. A large proportion of Latinos and Asian Americans live in ethnic enclaves—distinct neighborhoods with high concentrations of individuals of the same ethnic origin (“co-ethnic residents”) that are also characterized by recent immigration and linguistic isolation. The existing literature is mixed, with some studies showing that ethnic enclave residence (vs. non-enclave residence) and foreign- (vs. U.S.-) birthplace are associated with both better and/or worse outcomes across the cancer continuum. In this study, we will pool cancer registry data across five states (CA, FL, NJ, NY, TX) comprising the majority of Latinos and Asian Americans in the U.S. and link these data to contextual data characterizing the social, built and healthcare environments. We will determine whether and how ethnic enclave residence and foreign-birthplace are associated with three cancer outcomes (incidence, stage at diagnosis, survival) experienced by nine of the largest Latino and Asian ethnic groups (Cuban, Mexican, Puerto Rican, Chinese, Filipino, Japanese, Korean, South Asian, Vietnamese) diagnosed with three cancer types (breast, cervical, and colorectal cancers). Specifically, we aim to define and characterize ethnic enclaves, and examine cancer incidence by enclave residence (Aim 1) and determine independent and joint associations of ethnic enclave residence and nativity (foreign vs. US birthplace) on stage at diagnosis (Aim 2) as well as on mortality (Aim 3). With over 200,000 Latino and Asian American breast, colorectal, and cervical cancer cases, we will use multilevel models to understand the impact of ethnic enclaves on cancer outcomes for these understudied populations. In doing so, our study will accelerate discovery about the intersections between neighborhoods, ethnicity, nativity, and cancer and will improve data and methods used by central cancer registries across the U.S. Findings have potential to inform development of multilevel interventions to leverage enclave attributes that promote health and to address any barriers to reduce disparities and improve outcomes for our fastest growing ethnic minority and immigrant communities. We will disseminate our enclave measure and imputation procedures for missing data to the North American Association of Central Cancer Registries (NAACCR). In doing so, our methods will improve completeness of cancer registry data for surveillance of the growing Latino and Asian American populations. Our dissemination plan with collaboration from NAACCR leadership as well as the Offices of Community Outreach and Engagement at NCI Designated Cancer Centers in five states will ensure 1) methods are readily adopted by cancer registries and health disparities researchers across the nation; and 2) findings inform community-engaged efforts to address multilevel cancer disparities among Latino and Asian populations.