Using a socioeconomic position index to assess disparities in cancer incidence and mortality, Puerto Rico, 1995-2004.

INTRODUCTION: Evaluation of the extent of socioeconomic inequalities in cancer incidence and mortality is essential to generate hypotheses in population health research and provides evidence for population-based strategies for comprehensive cancer control. The objective of this study was to create an area-based socioeconomic position (SEP) index to assess possible socioeconomic disparities in incidence and mortality of selected cancers in Puerto Rico. METHODS: Data for cancer incidence and mortality from 1995 to 2004 were obtained from the Puerto Rico Central Cancer Registry and the Puerto Rico Department of Health, and Puerto Rico socioeconomic data were obtained from the US Census 2000. We used principal component and factor analysis methods to construct the SEP index at the municipality level. We calculated age-adjusted incidence and mortality for each SEP area and used rate ratios to evaluate the differences by SEP. RESULTS: Incidence and mortality of cancer in Puerto Rico varied by SEP area. In general, the incidence and mortality for cancers of the esophagus and stomach were higher for municipalities with the lowest SEP; in contrast, rates for breast, colorectal, kidney, pancreas, prostate, and thyroid were higher for areas with the highest SEP. CONCLUSION: These results highlight cancer disparities in Puerto Rico by SEP level that warrant further research.

Productivity loss in Puerto Rico's labor market due to cancer mortality.

BACKGROUND: In Puerto Rico (PR), cancer is the second leading cause of death and the disease that causes most premature deaths, representing about 15% of them. Thus, premature death due to cancer decreases the productivity capacity in PR. OBJECTIVE: This study aimed to estimate the labor-market productivity loss in PR during 2004 as a result of premature mortality due to overall cancer and cause-specific cancers. METHODS: A model based in the incidence-based approach and in the human capital approach was developed to estimate the labor-market productivity loss. Economic data were obtained from the Public Use Microdata Sample (PUMS) of the PR Community Survey (PRCS). Mortality data were obtained from the Vital Statistics of the PR Department of Health. RESULTS: The productivity costs of all cancer deaths were estimated to be approximately $64 million (in constant value). The cancer deaths that contributed the most to productivity loss were lung and bronchus, colorectal, breast, and liver and intrahepatic bile duct. CONCLUSIONS: Although these results must be interpreted with caution, this study contributes to show a broader picture that includes the economic dimension of cancer in our society. These estimates imply that productivity cost due to cancer mortality have a great burden in PR. The leading cancer sites that generate most productivity losses are highly preventable or can be diagnosed early or are related to tobacco consumption. This study should be considered within the framework of future cost analyses for the development of health and cancer control policies.

Risk of cancer among Hispanics with AIDS compared with the general population in Puerto Rico: 1987-2003.

BACKGROUND: The risk of cancer among Hispanics with Acquired Immune Deficiency Syndrome (AIDS) in the United States and Puerto Rico (PR) has not been well described. The purpose of this study was to determine the risk of AIDS related and non-AIDS related cancers among Hispanics with AIDS in PR. METHODS: A probabilistic record linkage of the PR AIDS Surveillance Program and PR Central Cancer Registry databases was conducted. AIDS cases were grouped according to year of AIDS onset and antiretroviral therapy availability: 1987-1989 (limited availability), 1990-1995 (mono and dual therapy), and 1996-2003 (highly active antiretroviral therapy: HAART). Cancer risk was described using the standardized incidence ratios (SIR). RESULTS: A total of 612 cancers were identified after 3 months of AIDS diagnosis: 409 (66.7%) AIDS related and 203 (33.1%) non-AIDS related. Although a decreasing trend in the risk of AIDS and non-AIDS related cancers was observed, the risk for both remained higher in the AIDS group compared to the general population in PR. Non-AIDS related cancers with higher risk during the HAART availability were: oropharyngeal, anal, liver, larynx, eye and orbit, Hodgkin lymphoma, and vaginal. CONCLUSION: Hispanics with AIDS in PR consistently showed a greater risk of AIDS and non-AIDS related cancers compared to the general population in PR and that has not changed over time.

Incidence and mortality of the leading cancer types in Puerto Rico: 1987-2004.

BACKGROUND: Cancer remains one of the leading causes of morbidity and mortality worldwide and is the second cause of death in Puerto Rico (PR). This article describes the incidence and the mortality from cancer in PR for the period of 1987 to 2004. METHODS: We analyzed data from the PR Central Cancer Registry and the PR Demographic Registry from 1987-2004, for the leading cancer types in men and women in PR. Age-adjusted incidence and mortality rates were estimated by sex, municipality, health region and primary site and were age-standardized to the 2000 PR population. RESULTS: Incidence rates for overall cancer remained constant in men and increased in women (APC = 0.6%, p < 0.05), while mortality rates decreased (APC = -1.0%) for both sexes. A significant increase was observed in the cancer incidence rates for colorectal cancer in men, while in women, an increase in breast, colorectal, and corpus and uterus cancer was observed. Mortality rates decreased for most of the major cancers types in both sexes, except for colorectal cancer in men which showed a significant increase (p < 0.05). CONCLUSION: The most important cancer types in PR (prostate, breast, colorectal, and lung) for both incidence and mortality are susceptible to primary prevention (eliminating or reducing risk factors) or to secondary prevention (early diagnosis) strategies. Our results are essential for the development of cancer prevention and control strategies in the Island.

Incidence trends of cervical cancer in Puerto Rico, 1987-2004.

OBJECTIVE: Cervical cancer was the leading malignancy among women in Puerto Rico when the Central Cancer Registry was first established by law in 1950. The screening program for cervical cancer in PR was initiated in 1961 when cytological laboratories were established in regional hospitals throughout the island, reaching its peak in 1973. In 2004, invasive cervical cancer ranked fifth among the top cancers in women in PR, representing 4% of all newly diagnosed cancers and 2% of all cancer-related deaths among women. The purpose of this study was to evaluate the incidence trends of cervical cancer by histology type in PR. METHODS: Cervical cancer cases (n = 3,516) diagnosed from 1987-2004 were obtained from the Puerto Rico Central Cancer Registry. Age-adjusted and age-specific incidence rates by histological type were calculated. Annual percent changes were estimated to evaluate the incidence trends from 1987 to 2004. RESULTS: From 1987 to 2004, the incidence of cervical cancer showed a downward trend (APC = -2.1%). Seventy-six percent (76.3%) of invasive cervical cancer cases were squamous cell carcinoma (SCC), 15.4% were adenocarcinoma (ADC), and 8.3% had other histologies. When histology was considered, a decreasing trend was observed for the incidence rates of SCC (APC = -3.2%, p < 0.05), with the greatest decrease being seen in women aged 60-74 (APC = -6.6%, p < 0.05). While the overall incidence rate of ADC remained stable (APC = 0.8%, p > 0.05), it increased in women aged 30-44 (APC = 3.8%, p < 0.05). CONCLUSION: Overall, the incidence rates for cervical cancer (SCC in particular), have decreased in PR. However, ADC does not present a similar decreasing trend. This trend, which is similar with other populations, could be explained, in part, by a decreasing prevalence of risk factors. Nevertheless, analysis by specific age group shows variations in the risk, which need careful consideration since they could imply changes in factors associated with each of the histological types.

Cancer disparities between mainland and island Puerto Ricans.

OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans- and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p<0.05) for major cancers-lung (SRRs=0.36 in males and 0.29 in females), prostate (SRR=0.71), female breast (SRR=0.73), and colon-rectum (SRRs=0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

Cancer disparities between mainland and island Puerto Ricans / Disparidades en la incidencia de cáncer en puertorriqueños residentes en los Estados Unidos y Puerto Rico

OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans-and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p < 0.05) for major cancers-lung (SRRs = 0.36 in males and 0.29 in females), prostate (SRR = 0.71), female breast (SRR = 0.73), and colon-rectum (SRRs = 0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

OBJETIVOS: Se analizaron las tasas de cáncer en un subgrupo de hispanos residentes en los Estados Unidos de América -los puertorriqueños (PRREUA) y se compararon sus tasas de incidencia con las de los puertorriqueños que residen en Puerto Rico (PRRPR) y la población estadounidense blanca sin ascendencia hispana (EUBNH) a fin de encontrar patrones de cáncer y disparidades de orden étnico específicos para los puertorriqueños. MÉTODOS: Se obtuvieron los datos de incidencia de los registros de cáncer de Puerto Rico y tres estados del nordeste de los Estados Unidos (New York, New Jersey y Connecticut) que tienen una elevada densidad de PRREUA. Se compararon las tasas ajustadas por la edad mediante las razones de las tasas estandarizadas (SRR). RESULTADOS: La incidencia total de cáncer fue menor en los PRRPR, intermedia en los PRREUA y mayor en los EUBNH. Los PRRPR presentaron tasas significativamente menores que los PRREUA (P < 0,05) en los principales tipos de cáncer -de pulmón (SRR = 0,36 en hombres; SRR = 0,29 en mujeres), próstata (SRR = 0,71), mama (SRR = 0,73) y colorrectal (SRR = 0,74 en hombres y SRR = 0,65 en mujeres)- así como en algunos tipos de cáncer menos frecuentes (de vejiga, hígado, riñón y pelvis renal, páncreas, tiroides, linfomas no Hodgkin, leucemia y melanoma de piel). En general, las tasas de cáncer en los PRREUA fueron ligeramente menores que las de los EUBNH, aunque de las tres poblaciones los PRREUA tuvieron las mayores tasas de cáncer de estómago, hígado y cervicouterino. CONCLUSIONES: A pesar de las desventajas socioeconómicas, los PRRPR tienen una menor incidencia relativa de cáncer. La identificación de los factores que contribuyen a ello podría ayudar en las investigaciones sobre cáncer, y comprender las razones del mayor riesgo de cáncer en los PRREUA podría facilitar el desarrollo de programas de intervención específicos para esta población.

Incidence and mortality rates for colorectal cancer in Puerto Rico and among Hispanics, non-Hispanic whites, and non-Hispanic blacks in the United States, 1998-2002.

BACKGROUND: Colorectal cancer (CRC) is the second most commonly diagnosed cancer in Puerto Rico (PR). In the United States, the incidence and mortality rates of CRC have great variation by sex and race/ethnicity. Age-standardized incidence and mortality rates of CRC in PR were assessed and compared with the rates among US Hispanics (USH), non-Hispanic whites (NHW), and non-Hispanic blacks (NHB) in the United States for the period from 1998 through 2002. Incidence and mortality trends and relative differences among racial/ethnic groups by sex and age were determined. METHODS: Age-standardized rates using the world standard population (ASR[World]) were based on cancer incidence and mortality data from the PR Central Cancer Registry and from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program using the direct method. The annual percentage changes (APC) and relative risks (RR) were calculated using Poisson regression models. RESULTS: During 1998 through 2002, the APC of CRC incidence and mortality increased for men in PR, whereas descending trends were observed for other racial/ethnic groups. Overall period rates indicated that, in both sexes, Puerto Ricans had CRC incidence and mortality rates similar to those for USH, but their rates were lower than those for NHW and NHB. However, Puerto Rican men and women ages 40 years to 59 years had the greatest risk of incidence and mortality compared with their USH counterparts. CONCLUSIONS: Areas of concern include the increasing trends of CRC in PR and the higher burden of the disease among young Puerto Ricans compared with the USH population. The authors concluded that further research should be performed to guide the design and implementation of CRC prevention and education programs in PR.