Kcomt Luisa, Gorey Kevin M
School of Social Work, University of Windsor, Windsor, Canada.
Ethn Health. 2020 Nov;25(8):1089-1102. doi: 10.1080/13557858.2018.1493432. Epub 2018 Jun 27.
Like the barrio advantage theory related to Mexican Americans, a theory about the protective effects of Chinese American enclaves is developing. Such protections were examined among socioeconomically vulnerable people with colon cancer. A colon cancer cohort established in California between 1995 and 2000, and followed until the enactment of the Affordable Care Act was utilized in this study. Secondary analysis was conducted on the 5-year survival among 127 Chinese Americans and 4524 other Americans (3810 non-Hispanic white and 714 Hispanic people). A third of the original cohort was selected from high poverty neighborhoods. Chinese American enclaves were neighborhoods where typically 25% or more of the residents were Chinese Americans. Effects were tested with Cox regressions and group differences described with age and stage-standardized survival rate ratios (RR). Though they were less adequately insured, Chinese American women residing in Chinese American enclaves (63%) were more likely to survive than were other Americans (50%, RR = 1.26). The protective effect of being married was also larger for Chinese Americans (RR = 1.31) than for others (RR = 1.17). Chinese American women (61%) were more likely than men (46%) to live in such enclaves and a large enclave survival advantage was observed among Chinese American women only (RR = 1.59). There is consistent evidence of the relatively protected status of Chinese American women, particularly those who were married and resided in Chinese American enclaves. Mechanisms that explain their apparent advantages are not yet well understood, though relatively large, kin-based social networks seem instrumental. Research on the influence of social networks as well as the possible effects of acculturation is needed. This study also exposed structural inequities related to the institutions of marriage, health care and communities that disadvantage others. Policy makers ought to be aware of them as future reforms of American health care are considered.
与墨西哥裔美国人的社区优势理论类似，一种关于美籍华人聚居区保护作用的理论正在形成。此类保护作用在患有结肠癌的社会经济弱势群体中得到了研究。本研究利用了1995年至2000年在加利福尼亚州建立的一个结肠癌队列，并对其进行随访，直至《平价医疗法案》颁布。对127名美籍华人以及4524名其他美国人（3810名非西班牙裔白人和714名西班牙裔）的5年生存率进行了二次分析。最初队列中有三分之一是从高贫困社区选取的。美籍华人聚居区是指通常25%或更多居民为美籍华人的社区。通过Cox回归检验效应，并使用年龄和阶段标准化生存率比值（RR）来描述组间差异。尽管美籍华人女性的医保覆盖情况较差（63%），但居住在美籍华人聚居区的她们比其他美国人（50%，RR = 1.26）更有可能存活。婚姻的保护作用对美籍华人（RR = 1.31）也比对其他人（RR = 1.17）更大。美籍华人女性（61%）比男性（46%）更有可能居住在这类聚居区，并且仅在美籍华人女性中观察到了较大的聚居区生存优势（RR = 1.59）。有一致证据表明美籍华人女性，尤其是已婚且居住在美籍华人聚居区的女性，处于相对受保护的状态。尽管基于亲属关系的相对庞大的社会网络似乎发挥了作用，但解释她们明显优势的机制尚未得到充分理解。需要开展关于社会网络影响以及文化适应可能产生的影响的研究。本研究还揭示了与婚姻、医疗保健和社区机构相关的结构性不平等，这些不平等对其他人不利。在考虑美国医疗保健未来改革时，政策制定者应该意识到这些问题。
