Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Ann Surg Oncol. 2024 Dec;31(13):9186-9195. doi: 10.1245/s10434-024-15761-4. Epub 2024 Sep 21.
Residence in ethnic enclaves and nativity are both associated with survival in Hispanic patients with cancer, although their prognostic significance in patients with hepatocellular carcinoma (HCC) is unknown. We aimed to determine the association between nativity, neighborhood socioeconomic status (nSES), and ethnic enclave residency with overall survival in Hispanic patients with HCC.
Hispanic patients diagnosed with HCC from 2004 to 2017 were identified in the Texas Cancer Registry. Existing indices were applied to tract-level 2000 US Census data to measure enclave residence and nSES. Enclaves were defined by seven measures. Multivariable Cox proportional hazard models were used to evaluate the association between nativity, enclave residency, and nSES with survival.
Among 9496 Hispanic patients with HCC, 2283 (24%) were foreign-born. Compared with US-born Hispanic patients, foreign-born Hispanic patients were less likely to present with localized HCC (45.3% vs. 48.8%, p = 0.03) and less likely to receive HCC treatment (53.9% vs. 47.6%, p < 0.001); however, foreign-born Hispanic patients had lower mortality in adjusted models (adjusted hazard ratio [aHR] 0.86, 95% confidence interval [CI] 0.79-0.93). Neighborhood SES, but not enclave residence, was also associated with overall survival. Compared with those in low nSES non-enclaves, Hispanic patients in high nSES neighborhoods, with either enclave (aHR 0.80, 95% CI 0.72-0.88) or non-enclave (aHR 0.89, 95% CI 0.80-0.98) residence status and low nSES enclaves (aHR 0.93, 95% CI 0.86-0.98) had improved survival.
In Hispanic patients with HCC, foreign birthplace and higher nSES, but not enclave residence, are associated with improved survival. Additional research on intersectionality between ethnicity, nativity, and neighborhood context is warranted.
居住在少数民族聚居区和出生地都与西班牙裔癌症患者的生存有关，尽管其在肝细胞癌（HCC）患者中的预后意义尚不清楚。我们旨在确定出生地、邻里社会经济地位（nSES）和少数民族聚居区居住与西班牙裔 HCC 患者总体生存的关系。
从德克萨斯癌症登记处确定了 2004 年至 2017 年期间诊断为 HCC 的西班牙裔患者。应用现有指数对 2000 年美国人口普查数据的区级进行评估，以衡量聚居区居住和 nSES。聚居区由七种措施定义。使用多变量 Cox 比例风险模型评估出生地、聚居区居住和 nSES 与生存之间的关系。
在 9496 名西班牙裔 HCC 患者中，有 2283 名（24%）是外国出生。与美国出生的西班牙裔患者相比，外国出生的西班牙裔患者更不可能出现局部 HCC（45.3% vs. 48.8%，p=0.03），也更不可能接受 HCC 治疗（53.9% vs. 47.6%，p<0.001）；然而，在调整后的模型中，外国出生的西班牙裔患者的死亡率较低（调整后的危险比[aHR]0.86，95%置信区间[CI]0.79-0.93）。邻里 SES，但不是聚居区居住，也与总体生存有关。与低 nSES 非聚居区的西班牙裔患者相比，居住在高 nSES 社区的西班牙裔患者，无论是聚居区（aHR 0.80，95%CI 0.72-0.88）还是非聚居区（aHR 0.89，95%CI 0.80-0.98），以及低 nSES 聚居区（aHR 0.93，95%CI 0.86-0.98）的生存状况均得到改善。
在西班牙裔 HCC 患者中，出生地和较高的 nSES，但不是聚居区居住，与生存改善有关。需要对族裔、出生地和邻里环境之间的交叉关系进行更多研究。
