Assessing racial, ethnic, and nativity disparities in US cancer mortality using a new integrated platform

Abstract

Background: Foreign-born populations in the United States have markedly increased, yet cancer trends remain unexplored. Survey-based Population-Adjusted Rate Calculator (SPARC) is a new tool for evaluating nativity differences in cancer mortality.

Methods: Using SPARC, we calculated 3-year (2016-2018) age-adjusted mortality rates and rate ratios for common cancers by sex, age group, race and ethnicity, and nativity. Trends by nativity were examined for the first time for 2006-2018. Traditional cancer statistics draw populations from decennial censuses. However, nativity-stratified populations are from the American Community Surveys, thus involve sampling errors. To rectify this, SPARC employed bias-corrected estimators. Death counts came from the National Vital Statistics System.

Results: Age-adjusted mortality rates were higher among US-born populations across nearly all cancer types, with the largest US-born, foreign-born difference observed in lung cancer among Black women (rate ratio = 3.67, 95% confidence interval [CI] = 3.37 to 4.00). The well-documented White-Black differences in breast cancer mortality existed mainly among US-born women. For all cancers combined, descending trends were more accelerated for US-born compared with foreign-born individuals in all race and ethnicity groups with changes ranging from -2.6% per year in US-born Black men to stable (statistically nonsignificant) among foreign-born Black women. Pancreas and liver cancers were exceptions with increasing, stable, or decreasing trends depending on nativity and race and ethnicity. Notably, foreign-born Black men and foreign-born Hispanic men did not show a favorable decline in colorectal cancer mortality.

Conclusions: Although all groups show beneficial cancer mortality trends, those with higher rates in 2006 have experienced sharper declines. Persistent disparities between US-born and foreign-born individuals, especially among Black people, necessitate further investigation.

Figure 1.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by sex, race and ethnicity, and nativity for all cancers combined. AAPC = average annual percent changes.

Figure 2.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by race and ethnicity, and nativity for female breast cancer. AAPC = average annual percent changes. * indicates that AAPC is statistically different from zero at 0.95 confidence level.

Figure 3.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by race and ethnicity, and nativity for prostate cancer. AAPC = average annual percent changes.

Figure 4.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by sex, race and ethnicity, and nativity for lung and bronchus cancer. AAPC = average annual percent changes.

Figure 5.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by sex, race and ethnicity, and nativity for colon and rectum cancer. AAPC = average annual percent changes.

Figure 6.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by sex, race and ethnicity, and nativity for pancreatic cancer. AAPC = average annual percent changes.

Figure 7.

Joinpoint trend analyses of annual age-adjusted mortality rates during 2006-2018 by sex, race and ethnicity, and nativity for liver and intrahepatic bile duct cancer. AAPC = average annual percent changes.