Eliseo J. Pérez Stable

Background: We evaluated county-level variations in racial and/or ethnic disparities in breast cancer mortality rates across the United States over a 20-year period. Methods: Validated small-area estimation models were used to calculate breast cancer mortality rates by age and race and/or ethnicity among females across all United States counties from 2000 to 2019. The estimates were corrected for misreporting of race and/or ethnicity on death certificates and age-standardized to the 2010 United States Census. Results: Age-standardized national breast cancer mortality rates declined between 2000 and 2019, from 33.6 (95% uncertainty interval = 33.4-33.9) to 24.8 (24.6-25.0) deaths per 100 000 females. However, there were variations in breast cancer mortality rates across racial and/or ethnic populations at the county level. For instance, 243 of 1478 counties showed increasing breast cancer mortality rates from 2000 to 2019 among Latina females aged <50 years (absolute increase [median] = 0.23 deaths per 100 000; maximum = 1.0). County-level patterns for American Indian/Alaska Native females aged 50-74 years showed increasing breast cancer mortality rates across 108 of 474 counties (median = 4.4 per 100 000; max = 17.5). The largest county-level increases were seen among American Indian/Alaska Native (184 of 474 counties; median = 15.2 per 100 000; max = 124.0) and Asian (589 of 667 counties; median = 14.1 per 100 000, max = 41.0) females aged 75+ years. Conclusions: Despite a substantial decrease in overall breast cancer mortality rates across all female populations combined in the United States, there were significant county-level variations in breast cancer mortality rates by race and/or ethnicity.

Rationale: Examining lung cancer mortality trends at the county level would better inform our understanding of racial, ethnic, and geographic differences in the United States. Objectives: To analyze lung cancer mortality trends by race and/or ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Latino, and White), sex, and county. Methods: Data from the National Vital Statistics System and National Center for Health Statistics (2000–2019) were used to estimate age-standardized lung cancer mortality in 3,110 counties, adjusted for misclassification. Results: From 2000 to 2019, lung cancer mortality decreased from 68.3 (95% uncertainty interval, 67.9–68.7) to 42.5 (42.3–42.8) deaths per 100,000. Males experienced a larger decrease (44.8%) than females (29.4%). Similar patterns were observed at the county level, with considerable geographic variation within and across racial and/or ethnic populations. In 2019, higher rates among Black and White populations were observed in the Mississippi River watershed and Appalachia and in AIAN populations in the upper Midwest, Northeast, North Carolina, Oklahoma, and Kansas. From 2000 to 2019, for males and females combined, lung cancer mortality rates increased in 57 counties (12.0%) for the AIAN population, with a median increase of 7.5 deaths per 100,000. Increases in counties were less common among Asian (n = 36, 5.4%), Latino (n = 36, 2.4%), and White (n = 1) populations, whereas no county showed an increase for Black individuals. Conclusions: Despite marked reductions in lung cancer mortality, geographic and racial and/or ethnic differences persist, which emphasizes the need for targeted interventions to further improve lung cancer outcomes for all populations.

Background/Objectives: Metabolic syndrome affects half of middle-aged (ages 45–64) Hispanic or Latino (Latino) adults. Pulses, fiber-rich plant proteins common in Latino diets (e.g., dry beans and lentils), may mitigate metabolic syndrome. We evaluated the association between pulse intake and metabolic syndrome. Methods: We analyzed data from 6,958 adults aged ≥ 50 in the Hispanic Community Health Study/Study of Latinos (2008–2011) Visit 1. Pulse intake was assessed using two 24 h dietary recalls and categorized into no, low (3/4 cup) daily intake groups. Metabolic syndrome was defined by criteria including blood pressure ≥130/85 mmHg or medication use, triglycerides ≥150 mg/dL or medication use, high-density lipoprotein cholesterol (men <40 mg/dL and women <50 mg/dL), and waist circumference (men ≥102 cm and women ≥88 cm). We used multivariate logistic regression models with predicted probability proportions to assess the association adjusted for sociodemographic factors, acculturation, diet quality, energy intake, and physical activity. Results: Of the 6,958 participants, 53.1% had metabolic syndrome and 53.4% had a moderate or high pulse intake. Pulse intake varied, where 19.4% had a high intake, 33.9% had a moderate intake, 12.5% had a low intake, and 34.2% had no intake. Moderate (predicted marginal = 0.52, 95% confidence interval [CI] = 0.49, 0.55) and high (predicted marginal = 0.49, 95%CI = 0.45, 0.53) intakes were associated with a lower prevalence of metabolic syndrome. Conclusions: Among Latino adults ≥50 years old, a moderate or high pulse intake was associated with a lower prevalence of metabolic syndrome. Increasing the pulse intake in the population may be linked to reduced metabolic syndrome.

Immigrants tend to exhibit better mental health compared to their U.S.-born counterparts, but this immigrant health advantage is not uniform across immigrant populations. The objective of this study is to examine if the immigrant health advantage extends to incarcerated individuals and if there are differences by race and/or ethnicity. We used data from the 2016 Survey of Prison Inmates (n=20,226) and multivariable linear and logistic regression models to examine the relationship between immigration status, race and/or ethnicity, and mental health (psychological distress, depression, anxiety) among imprisoned individuals. The analytic sample included Black (n=7,104), Latino (n=5,029), and White (n=8,093) respondents, ten percent of whom were foreign-born. The average Kessler 6-item psychological distress score was 5.9 and 24.4% and 19.8% of respondents reported ever having been diagnosed with depression and anxiety, respectively. Incarcerated U.S.-born individuals reported significantly more symptoms of psychological distress (β=0.89; C.I.=0.46,1.32; pβ=–1.64; C.I.=–2.99,–0.29; p<0.05) compared to incarcerated foreign-born Black individuals. No relationship between immigration status and mental health was observed among incarcerated White individuals. Findings suggest that the immigrant health advantage may vary by race and ethnicity within the imprisoned population.

Importance: Acculturation among Hispanic/Latino populations, defined as adaptation to US lifestyle and culture, is often assumed to lead to adverse health outcomes that will reduce the immigrant health advantage.Objective: To evaluate the risks for incident diabetes and hypertension by levels of acculturation and educational attainment.Design, Setting, and Participants: This study used data from the Hispanic Community Health Study/Study of Latinos, a population-based cohort study of men and women aged 18 to 74 years who identified as Central American, Cuban, Dominican, Mexican, Puerto Rican, or South American living in 4 urban locales in the US. Visit 1 spanned March 2008 to June 2011; visit 2 spanned October 2014 to December 2017.Main Outcomes and Measures: Multivariable logistic regression was used to evaluate the association between language acculturation level defined by the Short Acculturation Scale for Hispanics (SASH) and educational attainment (less than high school graduate vs more than high school) and incident diabetes and hypertension by heritage group.Results: Of 11 623 adult participants, 1207 (10.4%) were of Central American heritage, 1645 (14.2%) of Cuban heritage, 1021 (8.8%) of Dominican heritage, 11 623 (41.3%) of Mexican heritage, 1801 (15.5%) of Puerto Rican heritage, and 795 (6.8%) of South American heritage. The mean (SE) age of all participants was 43.1 (0.3) years, and 7345 (56.3%) were female. A total of 8697 (71.4%) were born outside the US, 4358 (32.5%) had less than a high school education, and 7475 (58.3%) were less acculturated (SASH score less than 2). Incident rates of diabetes (total cohort, 14.6% [95% CI, 13.6%-15.6%]) and hypertension (total cohort, 20.4% [95% CI, 19.0%-21.9%]) varied across heritages; Mexican individuals (17.2% [95% CI, 15.5%-19.0%]) had the highest diabetes incidence and Dominican individuals the highest hypertension incidence (27.1% [95% CI, 22.7%-31.4%]). Persons with more educational attainment were at lower risk for diabetes and hypertension independent of acculturation, and more acculturated participants had a lower risk for incident diabetes. Less acculturated with lower socioeconomic status (SES) were more likely to have incident diabetes (weighted predicted probability [WPP], 0.17 [95% CI, 0.14-0.19]), and more acculturated with lower SES had the highest predicted probability of hypertension (WPP, 0.19 [95% CI, 0.15-0.23]). More acculturated with higher SES were at lower risk of diabetes (WPP, 0.11 [95% CI, 0.09-0.13]) and had a lower predicted probability of hypertension (WPP, 0.10 [95% CI, 0.08-0.12]).Conclusions and Relevance: In this cohort study, the association of acculturation with health outcomes is not unidirectional and interacts with educational attainment in determining incident diabetes and hypertension. The Hispanic and Latino paradox, in which immigrants have a health advantage, is influenced by more factors than acculturation and may persist with higher educational attainment. These observations may inform prevention and treatment strategies associated with cardiometabolic health in Hispanic/Latino populations.

Objectives: The singular focus on self-identified race and ethnicity in health disparities research may not fully convey the individual and structural components of experiencing race in society, or in a racialized context such as prison. Processes of racialization create boundaries between incarcerated individuals and regulate their daily interactions and access to resources, with possible effects on well-being. However, the relationship between perceived race and health has not been examined within the imprisoned population. Design: We used data from the 2016 Survey of Prison Inmates ( n = 23,010) to assess how self-identified race, perceived race, and the discordance between racial self-identification and perception were associated with the physical (number of chronic conditions) and mental health (psychological distress) of American Indian and Alaska Native, Asian, Black, Latino, White, and multiracial incarcerated individuals. Results: Reported perception as Latino was associated with better mental and physical health relative to perception as White. Perceived Latino identity was more strongly associated with physical and mental health than a Latino self-identity. Reported perception as Black was associated with less psychological distress than perception as White, but this relationship dissipated after accounting for self-identified race. In contrast, perceived and self-identified multiracial incarcerated individuals reported worse health than their White counterparts. Having a discordant (vs. concordant) racial identity was associated with worse physical and mental health among imprisoned persons regardless of race. Conclusion: The use of a single, unidimensional measure of race and ethnicity in health disparities research does not fully reveal racialization’s influence on health, specifically for those experiencing incarceration.