A Neighborhood-Level Hispanic Paradox: The Interaction among Hispanic Density, Neighborhood Disadvantage, and Survival in Patients with Breast Cancer.

BACKGROUND

To evaluate the impact of Hispanic ethnic enclaves (EE) on the relationship between neighborhood disadvantage and overall survival in patients with breast cancer.

METHODS

Data from patients with stage I to IV breast cancer diagnosed between 2005 and 2017 were used to analyze the effects of area deprivation index (ADI) scores, a measure of neighborhood disadvantage, and census tract-level Hispanic density, a measure of EE, on overall survival using mixed-effects Cox regression models. The final model included the individual-level factors [age, income, race, Hispanic/Latino origin, nativity, insurance status, and comorbidities (hypertension, diabetes, and body mass index)] and clinical factors (National Comprehensive Cancer Network guideline-concordant treatment, stage, and receptor subtype).

RESULTS

A total of 5,387 patients were analyzed. Fifty-two percent resided in Hispanic EE. Enclave residents were predominantly White (93%), with Cubans the predominant subgroup (37%). Overall, there were 1,040 deaths within the cohort. Patients residing in highly disadvantaged neighborhoods (ADI tertile 3) within Hispanic EE experienced reduced HR compared with those outside of EE, evidenced by the interaction effect {EE × ADI tertile 3 - HR [95% confidence interval (CI)], 0.66 (0.44-0.98)}.

CONCLUSIONS

Hispanic EE may protect against mortality in patients with breast cancer, suggesting that positive social factors help combat negative effects of neighborhood disadvantage for patients. Understanding the protective attributes of EE can help create effective cancer interventions and promote more equitable outcomes in minority populations.

IMPACT

This study found that EE may protect against mortality in patients with breast cancer, suggesting that positive social factors may help mitigate the negative effects caused by the neighborhood.