Colon cancer care of Hispanic people in California: Paradoxical barrio protections seem greatest among vulnerable populations

Keren M Escobar; Mollie Sivaram; Kevin M Gorey; Isaac N Luginaah; Sindu M Kanjeekal; Frances C Wright

doi:10.4081/jphr.2020.1696

Colon cancer care of Hispanic people in California: Paradoxical barrio protections seem greatest among vulnerable populations

J Public Health Res. 2020 Jul 22;9(3):1696. doi: 10.4081/jphr.2020.1696. eCollection 2020 Jul 28.

Authors

Keren M Escobar¹, Mollie Sivaram², Kevin M Gorey¹, Isaac N Luginaah³, Sindu M Kanjeekal⁴, Frances C Wright⁵

Affiliations

¹ School of Social Work, University of Windsor, Ontario.
² Faculty of Health Sciences, McMaster University, Hamilton, Ontario.
³ Department of Geography, Western University, London, Ontario.
⁴ Department of Oncology, Windsor Regional Cancer Center and Schulich School of Medicine and Dentistry, Western University, Windsor, Ontario.
⁵ Division of General Surgery, Sunnybrook Health Sciences Center and cross appointed Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.

Abstract

Background: We examined paradoxical and barrio advantaging effects on cancer care among socioeconomically vulnerable Hispanic people in California. Methods: We secondarily analyzed a colon cancer cohort of 3,877 non-Hispanic white (NHW) and 735 Hispanic people treated between 1995 and 2005. A third of the cohort was selected from high poverty neighborhoods. Hispanic enclaves and Mexican American (MA) barrios were neighborhoods where 40% or more of the residents were Hispanic or MA. Key analyses were restricted to high poverty neighborhoods. Results: Hispanic people were more likely to receive chemotherapy (RR=1.18), especially men in Hispanic enclaves (RR=1.33) who were also advantaged on survival (RR=1.20). A survival advantage was also suggested among MA men who resided in barrios (RR=1.80). Conclusions: The findings were supportive of Hispanic paradox and MA barrio advantage theories. They further suggested that such advantages are greater for men, perhaps due to their greater spousal and extended familial support.

Keywords: Hispanic enclave; Hispanic paradox; barrio advantage; colon cancer; poverty.

Grants and funding

Funding: This study was supported in part with funds from the Canadian Institutes of Health Research (grant no. 67161-2) and an Ontario Graduate Scholarship. The funders had no role in study design, data collection, analysis or preparation of the manuscript.