Selected Findings
Selected findings from population-based studies of cancer treatment and treatment outcomes:
- The first population-based analysis of bone fractures after treatment with androgen antagonists in men with prostate cancer, estimating an approximately 7% absolute risk of any fracture and 3% risk of hospitalization for fracture within five years of starting an androgen antagonist (1). African Americans and Hispanics had lower risks than non-Hispanic whites.
- The first population-based analysis of the incidence of "androgen deprivation syndrome" in men treated with GnRH agonists for prostate cancer (2).
- GnRH use grew rapidly in the 1990's, largely in situations where evidence of efficacy was lacking (3). Hispanic men were more likely and non Hispanic black men less likely to receive androgen deprivation therapy than were non Hispanic whites (1,3).
- In multi level analyses, which urologist cared for the patient explained more of the variance in GnRH use than did stage or grade of cancer (4).
- Late cardiac toxicity following radiation for breast cancer declined substantially from the late 1970's to the late 1990's (5,6).
- Radiotherapy for prostate cancer is associated with a 19% absolute risk for late toxicity (eg. from 6 months to 5 years) but only a 1.2% risk of hospitalization for toxicity (7).
- Oral presentations at national oncology meetings of results of major clinical trials have an immediate and substantial effect on treatment choices in the community (8).
- A major reason why minority patients with stage 3 colon cancer do not receive chemotherapy is that they are never evaluated by an oncologist (9). Patients seeing older surgeons or surgeons not in multi-specialty groups are less likely to be referred to an oncologist (10). An analogous situation exists regarding referral to an oncologist and receipt of chemotherapy in patients with early stage lung cancer (submitted).
- Data from observational studies should be used with caution in comparing survival after different cancer treatments (11).
- Socioeconomic status is a strong predictor of survival after a melanoma diagnosis (12,13).
- The first population-based assessment of the incidence of jaw osteonecrosis after intravenous bisphosphonate use (14), with an absolute risk of approximately 5% at 5 years.
- Jaw osteonecrosis is equally common after intraveneous bisphosphonate osteoporosis as it is in cancer patients (submitted).
- Population-based estimates of variation among radiologists in their rate of false positive screening mammography (15). Non-Hispanic black patients were less likely than Hispanics or non Hispanic whites to have false positive screening mammograms.
- The use of hospice in advanced cancer is lower in Hispanics and Blacks compared to non-Hispanic whites (16), but these differences are diminishing over time (17).
Studies on the Hispanic paradox
- All cause mortality as well as cardiovascular and cancer mortality in Hispanics is influenced by neighborhoods. Hispanics living in census tracts that are mostly Hispanic have lower mortality than do Hispanics living in more heterogeneous neighborhoods (18). This would suggest that the Hispanic Paradox is most evident in Hispanics who have not become assimilated into the majority culture.
- Other health indicators in Hispanics have a similar relationship to neighborhood composition. Thus the incidence of most cancers (19) in Hispanics varies inversely with the percent composition of Hispanics in the neighborhood. The prevalence of depression shows a similar association (20).
- Inaccuracy in coding ethnicity on death certificates and other methodological errors can artifactually lower Hispanic mortality rates (21). We assessed the magnitude of this error in different groups using California vital registry versus census data. The Hispanic paradox persists after appropriate corrections (22).
- Older Hispanics in the US have lower all-cause mortality rates than non-Hispanic whites regardless of their place of birth. For younger Hispanics this advantage is only seen for foreign-born Hispanics (23)
- Residents of more homogeneous Hispanic and African American neighborhoods were more likely to be targeted by purveyors of Medicare fraud, and this effect of neighborhood was independent of individual ethnicity and other characteristics (24).
Health of Mexican Americans
- Anxiety is common and is a strong predictor of mortality in older Mexican Americans and African Americans (25, 26).
- Obesity has a similar impact on the health of older non-Hispanic blacks, non-Hispanic whites, and Hispanic Americans (27). The impact of obesity is greater on loss of functional independence than on mortality (27-31).
- Allostatic load in Mexican Americans varies by nativity, with foreign born Mexican Americans having lower allostatic load scores (submitted).
- Mild cognitive impairment is a major risk factor for subsequent disability (decline in muscle strength) among older Mexican Americans (42, 43).
- Impairment in near vision is associated with decline in cognitive status among older Mexican Americans (44).
