Large-scale immigration and political response: popular reaction in California

Race/ethnicity and changing US socioeconomic gradients in breast cancer incidence: California and Massachusetts, 1978-2002 (United States)

OBJECTIVE

We tested the hypothesis that the US socioeconomic gradient in breast cancer incidence is declining, with the decline most pronounced among racial/ethnic groups with the highest incidence rates.

METHODS

We geocoded the invasive incident breast cancer cases for three US population-based cancer registries covering: Los Angeles County, CA (1978-1982, 1988-1992, 1998-2002; n = 68,762 cases), the San Francisco Bay Area, CA (1978-1982, 1988-1992, 1998-2002; n = 37,210 cases) and Massachusetts (1988-1992, 1998-2002; n = 48,111 cases), linked the records to census tract area-based socioeconomic measures, and, for each socioeconomic stratum, computed average annual breast cancer incidence rates for the 5-year period straddling the 1980, 1990, and 2000 census, overall and by race/ethnicity and gender.

RESULTS

Our findings indicate that the socioeconomic gradient in breast cancer incidence is: (a) relatively small (at most 1.2) and stable among US white non-Hispanic and black women; (b) sharper and generally increasing among Hispanic and Asian and Pacific Islander American women; and (c) cannot be meaningfully analyzed without considering effect modification by race/ethnicity and immigration.

CONCLUSION

Our results indicate that secular changes in US socioeconomic gradients in breast cancer incidence exist and vary by race/ethnicity.

Impact of U.S. citizenship status on cancer screening among immigrant women

OBJECTIVES

We evaluated the relationship between U.S. citizenship status and the receipt of Pap smears and mammograms among immigrant women in California.

DESIGN

Cross-sectional study using data from the 2001 California Health Interview Survey.

PATIENTS/PARTICIPANTS

Noninstitutionalized, civilian women, aged 18 years and older living in California.

MEASUREMENTS AND MAIN RESULTS

We analyzed data from the 2001 California Health Interview Survey and used logistic regression models to adjust for sociodemographic factors and for access and utilization of health services. After adjusting we found that U.S. citizen immigrants were significantly more likely to report receiving a Pap smear ever (adjusted prevalence ratio [aPR], 1.05; 95% confidence interval [CI], 1.01 to 1.08), a recent Pap smear (aPR, 1.07; 95% CI, 1.03 to 1.11), a mammogram ever (aPR, 1.17; 95% CI, 1.12 to 1.21), and a recent mammogram (aPR, 1.38; 95% CI, 1.26 to 1.49) as compared to immigrants who are not U.S. citizens. Also associated with receiving cancer screening were income, having a usual source of care, and having health insurance. Hispanic women were more likely to receive Pap smears as compared to whites and Asians.

CONCLUSIONS

Not being a U.S. citizen is a barrier to receiving cervical and breast cancer screening. Additional research is needed to explore causal factors for differences in cancer screening rates between citizens and noncitizens.