ASPO Abstracts
Cancer mortality among Asian American ethnicities, by nativity and etiology of cancer (2008-2017)
Category: Cancer Health Disparities
Conference Year: 2021
Abstract Body:
Purpose:Prior studies show foreign born having lower mortality rates than US-born, without
disaggregation by ethnicity. Asian Americans (AA) are the fastest growing ethnic group in the US with
a large proportion being foreign-born. But recency of immigration vary by AA ethnicity. We sought to
better understand the role of nativity in cancer mortality burden by specific AA ethnicity.
Methods: The study included 98,826 decedents (2008-2017) identified as Asian Indian, Chinese,
Filipino, Japanese, Korean or Vietnamese on death certificate data from the National Center for
Health Statistic (NCHS). Year of death, age, sex (male/female), ethnicity, underlying cause of death
(ICD-10), nativity (foreign born/US born) were extracted. We chose and categorized cancer sites that
contribute significantly to AA cancer mortality by suspected etiology: Tobacco-related (colon/rectum,
oral cavity/pharynx, leukemia, lung/bronchus, kidney/renal, pancreas), Screen-detected
(colon/rectum, female breast, prostate), Infection related (oral cavity/pharynx, liver, non-Hodgkin
lymphoma, stomach), and obesity/diet related (colon/rectum, female breast, ovary, uterine corpus).
Population counts were obtained from U.S. Census (IPUMS). We calculated 10-year age-adjusted
mortality rates (AAMR; per 100,000) and indirectly standardized mortality ratios (SMR) to compare
observed U.S born deaths to expected deaths if they experienced same rates as foreign born.
Results: The proportion of foreign-born ranged from 75% in Korean to 44% in Japanese. Overall
cancer mortality rates were similar by nativity. By etiology, tobacco related cancers had the highest
mortality rates with the highest in Filipino males (foreign-born AAMR: 57.3 (55.7-58.9), US-born
AAMR: 55.4 (50.0-60.8). U.S-born had lower mortality compared to foreign-born, except for Japanese
males where US-born had higher mortality than expected [tobacco related SMR 1.3 (1.2-1.4), screen-
detected SMR 1.3 (1.2-1.3)].Conclusions: Our results show higher mortality rates in foreign-born
compared to US-born; especially in infection and tobacco related cancers. This is unexpected
assuming the healthy immigrant effect. Cancer prevention programs targeting AA may consider
increased screening for infectious etiologies, particularly among foreign-born
Keywords: cancer, mortality, nativity, Asian Americans