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Hispanics/Latinos in the Bronx Have Improved Survival in Non-Small Cell Lung Cancer Compared with Non-Hispanic Whites

  • Madelyn KlugmanEmail author
  • Xiaonan Xue
  • Mindy Ginsberg
  • Haiying Cheng
  • Thomas Rohan
  • H. Dean HosgoodIII
Article
  • 11 Downloads

Abstract

Background

Hispanics/Latinos are a growing yet understudied population in the United States (US). Despite lower socioeconomic status, Hispanics/Latinos tend to have similar or better health outcomes than Non-Hispanic Whites (NHWs). This phenomenon has not been conclusively studied for lung cancer.

Methods

Using a cohort of patients at Montefiore Medical Center (MMC) in the Bronx, NY, we examined factors related to lung cancer survival by race/ethnicity with an emphasis on Hispanics/Latinos. Subjects were diagnosed with non-small cell lung cancer (NSCLC) between 2004 and 2017. Demographic and clinical data were obtained from MMC’s clinical systems and tumor-related information from MMC/Einstein’s Cancer Registry. Survival was assessed using Cox proportional hazards modeling adjusted for clinical and sociodemographic factors including smoking. Factors related to survival within each major racial/ethnic group were examined.

Results

Hispanics/Latinos experienced decreased risk of death relative to NHWs [hazard ratio (HR) = 0.70, 95% confidence interval (95%CI) 0.57–0.86] overall and by sex (males: HR = 0.78, 95%CI 0.59–1.03, females: HR = 0.61, 95%CI 0.44–0.86). Decreased risk among Hispanics/Latinos relative to NHWs was evident in never-smokers (HR = 0.55, 95%CI 0.29–1.01), ever-smokers (HR = 0.72, 95%CI 0.57–0.90), younger subjects (HR = 0.73, 95%CI 0.54–0.99), and older subjects (HR = 0.72, 95%CI 0.53–0.97). Surgery was associated with improved survival in Hispanics/Latinos (HR = 0.60, 95%CI 0.43–0.85), and smoking with worse survival (HR = 1.56, 95%CI 1.02–2.39). Survival did not differ between Non-Hispanic Blacks and NHWs.

Conclusions

In a poor urban community, Hispanics/Latinos experience improved survival from NSCLC compared to NHWs, which is not entirely explained by smoking. Future research should investigate the drivers of this benefit and differences in survival by Hispanic/Latino origin.

Keywords

Lung Epidemiology Race Ethnicity Mortality 

Notes

Acknowledgements

We would like to thank Dr. Aileen McGinn, who provided insight on data analysis that greatly assisted the research.

Author Contributions

M.K conducted the study under the direction of H.D.H. X.X. provided insight and guidance with respect to statistical methods. M.G. provided insight and guidance with respect to electronic medical record data. M.K., X.X., M.G., H.C., T.R., and H.D.H. discussed the results and contributed to the final manuscript.

Funding Information

This work was supported in part by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number ULITR001073. The funder had no direct role in the conduct of this study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Institutional Review Board at Albert Einstein College of Medicine, reference number 043574) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

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References

  1. 1.
    Haile RW, John EM, Levine AJ, Cortessis VK, Unger JB, Gonzales M, et al. A review of cancer in U.S. Hispanic populations. Cancer Prev Res (Phila). 2012;5(2):150–63.  https://doi.org/10.1158/1940-6207.CAPR-11-0447.CrossRefGoogle Scholar
  2. 2.
    McDonald JA, Paulozzi LJ. Parsing the paradox: hispanic mortality in the US by detailed cause of death. J Immigr Minor Health. 2019;21(2):237–45.  https://doi.org/10.1007/s10903-018-0737-2.CrossRefPubMedGoogle Scholar
  3. 3.
    Pinheiro PS, Callahan KE, Siegel RL, Jin H, Morris CR, Trapido EJ, et al. Cancer Mortality in Hispanic Ethnic Groups. Cancer Epidemiol Biomarkers Prev. 2017;26(3):376–82.  https://doi.org/10.1158/1055-9965.epi-16-0684.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ruiz JM, Steffen P, Smith TB. Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature. Am J Public Health. 2013;103(3):e52–60.  https://doi.org/10.2105/ajph.2012.301103.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Blue L, Fenelon A. Explaining low mortality among US immigrants relative to native-born Americans: the role of smoking. Int J Epidemiol. 2011;40(3):786–93.  https://doi.org/10.1093/ije/dyr011.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Eschbach K, Ostir GV, Patel KV, Markides KS, Goodwin JS. Neighborhood context and mortality among older Mexican Americans: is there a barrio advantage? Am J Public Health. 2004;94(10):1807–12.  https://doi.org/10.2105/ajph.94.10.1807.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rodriguez CJ, Allison M, Daviglus ML, Isasi CR, Keller C, Leira EC, et al. Status of cardiovascular disease and stroke in Hispanics/Latinos in the United States: a science advisory from the American Heart Association. Circulation. 2014;130(7):593–625.  https://doi.org/10.1161/cir.0000000000000071.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Underwood JM, Townsend JS, Tai E, Davis SP, Stewart SL, White A, et al. Racial and regional disparities in lung cancer incidence. Cancer. 2012;118(7):1910–8.  https://doi.org/10.1002/cncr.26479.CrossRefPubMedGoogle Scholar
  9. 9.
    Stat bite: Mortality from lung and bronchus cancer by race/ethnicity, 1998-2002. J Natl Cancer Inst. 2006;98(3):158.  https://doi.org/10.1093/jnci/djj056.
  10. 10.
    Saeed AM, Toonkel R, Glassberg MK, Nguyen D, Hu JJ, Zimmers TA, et al. The influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient survival: an analysis of the Survival, Epidemiology, and End Results database. Cancer. 2012;118(18):4495–501.  https://doi.org/10.1002/cncr.26686.CrossRefPubMedGoogle Scholar
  11. 11.
    Pinheiro PS. The influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient survival : an analysis of the Survival, epidemiology, and end results database. Cancer. 2013;119(6):1285–6.  https://doi.org/10.1002/cncr.27803.CrossRefPubMedGoogle Scholar
  12. 12.
    Brzezniak C, Satram-Hoang S, Goertz HP, Reyes C, Gunuganti A, Gallagher C, et al. Survival and racial differences of non-small cell lung cancer in the United States Military. J Gen Intern Med. 2015;30(10):1406–12.  https://doi.org/10.1007/s11606-015-3280-z.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tannenbaum SL, Koru-Sengul T, Zhao W, Miao F, Byrne MM. Survival disparities in non-small cell lung cancer by race, ethnicity, and socioeconomic status. Cancer J. 2014;20(4):237–45.  https://doi.org/10.1097/ppo.0000000000000058.CrossRefPubMedGoogle Scholar
  14. 14.
    Klugman M, Xue X, Hosgood HD 3rd. Race/ethnicity and lung cancer survival in the United States: a meta-analysis. Cancer Causes Control. 2019;30(11):1231–41.  https://doi.org/10.1007/s10552-019-01229-4.CrossRefPubMedGoogle Scholar
  15. 15.
    Sorlie PD, Aviles-Santa LM, Wassertheil-Smoller S, Kaplan RC, Daviglus ML, Giachello AL, et al. Design and implementation of the Hispanic Community Health Study/Study of Latinos. Ann Epidemiol. 2010;20(8):629–41.  https://doi.org/10.1016/j.annepidem.2010.03.015.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Community. Montefiore. https://www.montefiore.org/community. Accessed 23 Jun 2019.
  17. 17.
    QuickFacts Bronx County (Bronx Borough), New York US Census Bureau https://www.census.gov/quickfacts/fact/table/bronxcountybronxboroughnewyork/RHI225218#RHI225218. Accessed 8 Jul 2019.
  18. 18.
    Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001;345(2):99–106.  https://doi.org/10.1056/nejm200107123450205.CrossRefPubMedGoogle Scholar
  19. 19.
    Cancer Programs. American College of Surgeons. https://www.facs.org/search/cancer-programs?name = montefiore. Accessed 2 Jul 2019.
  20. 20.
    FORDS: Facility Oncology Registry Data Standards Revised for 2016. Commission on Cancer of the American College of Surgeons. 2016. https://www.facs.org/~/media/files/quality%20programs/cancer/ncdb/fords%202016.ashx. Accessed May 24, 2019 2018.
  21. 21.
    Shariff-Marco S, Yang J, John EM, Sangaramoorthy M, Hertz A, Koo J, et al. Impact of neighborhood and individual socioeconomic status on survival after breast cancer varies by race/ethnicity: the Neighborhood and Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2014;23(5):793–811.  https://doi.org/10.1158/1055-9965.epi-13-0924.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Du XL, Fang S, Coker AL, Sanderson M, Aragaki C, Cormier JN, et al. Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer. 2006;106(6):1276–85.  https://doi.org/10.1002/cncr.21732.CrossRefPubMedGoogle Scholar
  23. 23.
    Kleinbaum D, Klein M. The stratified Cox procedure. Survival analysis. New York: Springer; 2012.CrossRefGoogle Scholar
  24. 24.
    DiNapoli TP. An economic snapshot of the Bronx. Office of the New York State Comptroller. 2018. https://osc.state.ny.us/osdc/rpt4-2019.pdf. Accessed 8 Jul 2019.Google Scholar
  25. 25.
    Markides KS, Coreil J. The health of Hispanics in the southwestern United States: an epidemiologic paradox. Public Health Rep. 1986;101(3):253–65.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Weden MM, Miles JNV, Friedman E, Escarce JJ, Peterson C, Langa KM, et al. The Hispanic paradox: race/ethnicity and nativity, immigrant enclave residence and cognitive impairment among older US Adults. J Am Geriatr Soc. 2017;65(5):1085–91.  https://doi.org/10.1111/jgs.14806.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Arias E, Eschbach K, Schauman WS, Backlund EL, Sorlie PD. The Hispanic mortality advantage and ethnic misclassification on US death certificates. Am J Public Health. 2010;100(Suppl 1):S171–7.  https://doi.org/10.2105/ajph.2008.135863.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Medina-Inojosa J, Jean N, Cortes-Bergoderi M, Lopez-Jimenez F. The Hispanic paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis. 2014;57(3):286–92.  https://doi.org/10.1016/j.pcad.2014.09.001.CrossRefPubMedGoogle Scholar
  29. 29.
    Abraido-Lanza AF, Dohrenwend BP, Ng-Mak DS, Turner JB. The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses. Am J Public Health. 1999;89(10):1543–8.CrossRefGoogle Scholar
  30. 30.
    Turra CM, Elo IT. The impact of salmon bias on the hispanic mortality advantage: new evidence from social security data. Popul Res Policy Rev. 2008;27(5):515–30.  https://doi.org/10.1007/s11113-008-9087-4.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Fenelon A. Revisiting the Hispanic mortality advantage in the United States: the role of smoking. Soc Sci Med. 2013;82:1–9.  https://doi.org/10.1016/j.socscimed.2012.12.028.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860–7.  https://doi.org/10.1001/jama.292.23.2860.CrossRefPubMedGoogle Scholar
  33. 33.
    Reyes-Guzman CM, Pfeiffer RM, Lubin J, Freedman ND, Cleary SD, Levine PH, et al. Determinants of light and intermittent smoking in the United States: results from three pooled national health surveys. Cancer Epidemiol Biomarkers Prev. 2017;26(2):228–39.  https://doi.org/10.1158/1055-9965.EPI-16-0028.CrossRefPubMedGoogle Scholar
  34. 34.
    Patel MI, Schupp CW, Gomez SL, Chang ET, Wakelee HA. How do social factors explain outcomes in non-small-cell lung cancer among Hispanics in California? Explaining the Hispanic paradox. J Clin Oncol. 2013;31(28):3572–8.  https://doi.org/10.1200/JCO.2012.48.6217.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Fang S, Wang Z. EGFR mutations as a prognostic and predictive marker in non-small-cell lung cancer. Drug Des Devel Ther. 2014;8:1595–611.  https://doi.org/10.2147/DDDT.S69690.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Gimbrone NT, Sarcar B, Gordian ER, Rivera JI, Lopez C, Yoder SJ, et al. Somatic mutations and ancestry markers in Hispanic lung cancer patients. J Thorac Oncol. 2017;12(12):1851–6.  https://doi.org/10.1016/j.jtho.2017.08.019.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Arrieta O, Cardona AF, Federico Bramuglia G, Gallo A, Campos-Parra AD, Serrano S, et al. Genotyping non-small cell lung cancer (NSCLC) in Latin America. J Thorac Oncol. 2011;6(11):1955–9.  https://doi.org/10.1097/JTO.0b013e31822f655f.CrossRefPubMedGoogle Scholar
  38. 38.
    Zhang W, McQuitty EB, Olsen R, Fan H, Hendrickson H, Tio FO, et al. EGFR mutations in US Hispanic versus non-Hispanic white patients with lung adenocarcinoma. Arch Pathol Lab Med. 2014;138(4):543–5.  https://doi.org/10.5858/arpa.2013-0311-OA.CrossRefPubMedGoogle Scholar
  39. 39.
    Lerner L, Winn R, Hulbert A. Lung cancer early detection and health disparities: the intersection of epigenetics and ethnicity. J Thorac Dis. 2018;10(4):2498–507.  https://doi.org/10.21037/jtd.2018.04.07.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Biswas T, Walker P, Podder T, Rosenman J, Efird J. Important prognostic factors for lung cancer in tobacco predominant Eastern North Carolina: study based on a single cancer registry. Lung Cancer. 2014;84(2):116–20.  https://doi.org/10.1016/j.lungcan.2014.01.026.CrossRefPubMedGoogle Scholar
  41. 41.
    Aldrich MC, Grogan EL, Munro HM, Signorello LB, Blot WJ. Stage-adjusted lung cancer survival does not differ between low-income Blacks and Whites. J Thorac Oncol. 2013;8(10):1248–54.  https://doi.org/10.1097/JTO.0b013e3182a406f6.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Pennella E, Obasaju CK, Pohl G, Peltz G, Girvan AC, Winfree KB, et al. Prospective observational comparison of clinical outcomes between african-american and caucasian patients receiving second-line treatment with pemetrexed for advanced non-small-cell lung cancer. Clin Lung Cancer. 2013;14(6):726–35.  https://doi.org/10.1016/j.cllc.2013.06.011.CrossRefPubMedGoogle Scholar
  43. 43.
    Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomarkers Prev. 2006;15(1):25–31.  https://doi.org/10.1158/1055-9965.epi-05-0537.CrossRefPubMedGoogle Scholar
  44. 44.
    Xu T, Wei Q, Lopez Guerra JL, Wang LE, Liu Z, Gomez D, et al. HSPB1 gene polymorphisms predict risk of mortality for US patients after radio(chemo)therapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2012;84(2):e229–35.  https://doi.org/10.1016/j.ijrobp.2012.03.032.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Williams CD, Salama JK, Moghanaki D, Karas TZ, Kelley MJ. Impact of race on treatment and survival among U.S. veterans with early-stage lung cancer. J Thorac Oncol. 2016;11(10):1672–81.  https://doi.org/10.1016/j.jtho.2016.05.030.CrossRefPubMedGoogle Scholar
  46. 46.
    Sullivan DR, Chan B, Lapidus JA, Ganzini L, Hansen L, Carney PA, et al. Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration. JAMA Oncol. 2019.  https://doi.org/10.1001/jamaoncol.2019.3105.
  47. 47.
    Merzel CR, Isasi CR, Strizich G, Castaneda SF, Gellman M, Maisonet Giachello AL, et al. Smoking cessation among U.S. Hispanic/Latino adults: findings from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prev Med. 2015;81:412–9.  https://doi.org/10.1016/j.ypmed.2015.10.006.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  2. 2.Division of Medical Oncology, Department of MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxUSA

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