Abstract PR12: Examining the Latina paradox: Impact of neighborhood Latina density on breast cancer survival in Texas
Authors: Pruitt Sandi L. , Lee Simon Craddock , Ruiz John M. , Xuan Lei , Tiro Jasmin A. 
Published: October 2015

Abstract
Purpose: Despite a worse risk factor profile, Latina breast cancer patients often experience better survival outcomes compared to whites. The reasons for this Paradox are unclear and may reflect advantages that are largely social and cultural in nature. We examine whether the percent of other Latinas in a patient's neighborhood a marker of local area social and cultural context moderates Latina-white differences in survival among breast cancer patients.
Methods: We examined all-cause and breast-cancer specific mortality among female adult (≥18 years) non-Latina white and Latina breast cancer patients, diagnosed 1995-2009 and recorded in the Texas Cancer Registry (TCR). We linked TCR data to mammography machine data obtained from the FDA and U.S. Census data. We examined the associations and interactions of patient Latina ethnicity and neighborhood percent Latina using shared frailty Cox proportional hazard models (patients nested within census tracts.) Covariates included patient age, diagnosis year, tumor stage, grade, histology, urban/rural residence, and local area mammography capacity.
Results: Of 151,275 Texas women, Latinas (vs. whites) were more likely to live in urban, high poverty, high Latina density, and poor mammography capacity neighborhoods. Univariate survival analyses indicated that Latinas (vs. whites) were more likely to die from breast cancer-specific causes (HR: 1.24; 95% CI: 1.19-1.28) and less likely to die from all-causes (HR: 0.88; 95% CI: 0.86-0.90). The interaction between patient Latina ethnicity and neighborhood Latina density and was statistically significant for both breast cancer and all-cause death (p&lt;.0001). In adjusted all-cause mortality models including all covariates and the patient*neighborhood Latina interaction term, the hazard ratio of Latinas (vs. whites) reversed direction (aHR: 1.10; 95% CI: 1.04-1.15) such that Latinas were more likely to die. Both Latinas and whites living in higher Latina density neighborhoods were more likely to die from both outcomes.
Discussion: Findings were surprising, because prior research has found Latinas experience protective effects of ethnic enclaves (areas with greater Latina density). Here we found the opposite to be true. Given the heterogeneity of the Latina population, effects of Latina ethnicity on mortality must be disentangled from shared language preferences, socioeconomic and contextual factors. We are currently analyzing the synergistic impact of nativity, neighborhood poverty and the percentage of foreign-born neighborhood residents on cancer mortality. This knowledge is critical to inform intervention design including targeting subgroups of Latinas in Texas at highest risk for breast cancer mortality.
This abstract was also presented as Poster B24.
Citation Format: Sandi L. Pruitt, Simon Craddock Lee, John M. Ruiz, Lei Xuan, Jasmin A. Tiro. Examining the Latina paradox: Impact of neighborhood Latina density on breast cancer survival in Texas. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr PR12.