Paulo Pinheiro, MD, MSc, PhD, Associate Professor Epidemiology, University of Nevada Las Vegas (NAACCR Committee Member)
Significant disparities between Blacks, or Americans of African descent, and the majority non-Hispanic white population for cancer incidence, survival and mortality are well-documented. For research purposes, Blacks have been typically aggregated as one large population group, as NAACCR does not collect specific information on descent for non-Hispanic Blacks. However, our colleagues at the University of Nevada Las Vegas (UNLV) used mortality data from Florida to examine heterogeneity within the Black population, finding surprising differences between US-born Blacks, and Jamaicans and Haitians (Afro-Caribbean populations) residing in Florida.
US-born Blacks had exceedingly high mortality rates, nearly double that of their Caribbean counterparts, whose rates were similar to or lower than non-Hispanic whites for many cancers. Haitians in Florida had the lowest mortality for all cancers combined and for the greatest causes of cancer mortality: lung, colorectal, breast, and prostate; Jamaican rates were intermediate between Haitian and US-born Black rates. Perhaps most surprising is that even for infection-related cancers, typically ascribed to immigrant populations, US-born Black men had higher mortality for liver and stomach cancer, and US-born Black women had higher cervical cancer mortality than Jamaicans or Haitians. Also, the patterns among Jamaicans and Haitians in the US vary according to cancer site, and these patterns are not always compatible with the widely known “healthy immigrant effect”.
These results assume great importance for aggregated rates in states such as New York and Florida with significant diversity in the Black population, as the inclusion of these relatively healthier populations has the effect of pulling down the rates and underestimating the true mortality burden for US-born Blacks, shown here to be even worse than previously documented. This work also highlights the importance of better understanding the role of acculturation among immigrant groups in cancer risk.
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Abstract
Introduction: The quantitative intraracial burden of cancer incidence, survival and mortality within black populations in the United States is virtually unknown.
Methods: We computed cancer mortality rates of US- and Caribbean-born residents of Florida, specifically focusing on black populations (United States, Haiti, Jamaica) and compared them using age-adjusted mortality ratios obtained from Poisson regression models. We compared the mortality of Haitians and Jamaicans residing in Florida to populations in their countries of origin using Globocan.
Results: We analyzed 185,113 cancer deaths from 2008 to 2012, of which 20,312 occurred in black populations. The overall risk of death from cancer was 2.1 (95% CI: 1.97–2.17) and 1.6 (95% CI: 1.55–1.71) times higher for US-born blacks than black Caribbean men and women, respectively (P < .001).
Conclusions: Race alone is not a determinant of cancer mortality. Among all analyzed races and ethnicities, including Whites and Hispanics, US-born blacks had the highest mortality rates while black Caribbeans had the lowest. The biggest intraracial difference was observed for lung cancer, for which US-blacks had nearly 4 times greater mortality risk than black Caribbeans. Migration from the islands of Haiti and Jamaica to Florida resulted in lower cancer mortality for most cancers including cervical, stomach, and prostate, but increased or stable mortality for 2 obesity-related cancers, colorectal and endometrial cancers. Mortality results in Florida suggest that US-born blacks have the highest incidence rate of “aggressive” prostate cancer in the world, rather than Caribbean men.
The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.
