Nativity and neighborhood characteristics and cervical cancer stage at diagnosis and survival outcomes among Hispanic women in California

Am J Public Health. 2015 Mar;105(3):538-45. doi: 10.2105/AJPH.2014.302261. Epub 2015 Jan 20.


Objectives: We examined stage of diagnosis and survival after cervical cancer among Hispanic women, and their associations with Hispanic nativity, and explored whether neighborhood socioeconomic status (SES) and residence in a Hispanic enclave modify the association of nativity with stage and survival.

Methods: We used California Cancer Registry data (1994-2009) to identify 7958 Hispanic women aged 21 years and older with invasive cervical cancer. We used logistic and Cox proportional hazards models to estimate the associations between stage and mortality with nativity, neighborhood factors, and other covariates.

Results: Foreign-born women had similar adjusted relative odds of being diagnosed with stages II through IV (vs stage I) cervical cancer compared with US-born Hispanic women. However, among foreign-born women, those in low-SES-low-enclave neighborhoods were more likely to have late-stage disease than those in high-SES-low-enclave neighborhoods (adjusted odds ratio=1.91; 95% confidence interval=1.18, 3.07). Foreign-born women had lower cervical cancer mortality (adjusted hazard ratio=0.67; 95% confidence interval=0.58, 0.76) than US-born women, but only in high enclaves.

Conclusions: Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • California / epidemiology
  • Confidence Intervals
  • Emigrants and Immigrants / statistics & numerical data
  • Female
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Odds Ratio
  • Proportional Hazards Models
  • Residence Characteristics*
  • SEER Program / statistics & numerical data
  • Social Class
  • Uterine Cervical Neoplasms / diagnosis
  • Uterine Cervical Neoplasms / ethnology*
  • Uterine Cervical Neoplasms / pathology
  • Young Adult