Table 4.

Articles on Ethnic Density/Segregation and Cancer Mortality

Reference	Ethnic Density Measure(s)	Dataset	Sample	Outcome(s)	Association	Main Findings
Black neighborhood
Cooper (1997)13	% Black	329 US counties (1989–1991)	148,947 Medicare beneficiaries with colorectal cancer aged 65+ years	2-year mortality among CRC cases	+	As % Blacks in the county increased, 2-year mortality rates for both White and Black patients increased
Russell (2011)47	% Black	GA Cancer Registry (1999–2003)	15,256 Black and White women with breast cancer	Breast cancer- specific mortality	+	Increasing % Black residents was associated with higher breast cancer-specific mortality for all women
Russell (2012)48	% Black;	GA Cancer Registry (1999–2003)	20,088 Black and White women with breast cancer	Breast cancer- specific and all-cause mortality	+	Increasing % Black residents was associated with higher all-cause mortality for White (but not Black) women.
	Theil Index					Increasing segregation was associated with higher breast cancer-specific mortality for Black (but not White) women.
Warner (2010)8	% Black;	CA Cancer Registry (1996–2004)	8,482 non-Hispanic Black and 95,672 NHW women with breast cancer	Breast cancer- specific and all-cause mortality	+ (Whites)	Among Whites, living in neighborhoods with greater % Blacks was associated with higher all-cause mortality. Among Blacks, living in neighborhoods with ≥20% Blacks was associated with lower breast cancer-specific and all-cause mortality. Protective effect was observed across most segregation measures.
	Dissimilarity;				— (Blacks)
	Delta;
	Isolation;
	Relative centralization;
	Spatial proximity
Lim (2011)49	% Black	Los Angeles County Cancer Registry (1997- 2003)	1811 women with cervical cancer	Cervical cancer-specific mortality	+	Living in neighborhoods with a high proportion of Black households was associated with increased risk of death
	% Hispanic
	% Asian
Pruitt (2015)10	Location quotient	TX Cancer Registry (1995–2009)	109,749 Black, Hispanic, and White women with breast cancer aged 50+ yrs	Breast cancer-specific and all-cause mortality	+	Among all women, higher Black segregation was associated with greater all-cause mortality.
						In analyses stratified by patient race/ethnicity, greater segregation was not associated with greater mortality among Blacks.
Bemanian (2017)11	Location quotient	WI Cancer Reporting System (2002–2011)	7,164 White, 940 Black, and 252 Hispanic women with breast cancer	Breast cancer-specific and all-cause mortality	—	In race-stratified analyses, Black patients residing in areas of high Black isolation had lower breast cancer-specific and all-cause mortality.
	Local exposure & isolation (Lex/Is)
	Index of concentration at extremes (ICE)
Zhou (2017)12	Location quotient	WI Cancer Reporting System (2002–2011)	4,699 Whites and 682 Blacks with colorectal cancer	Colorectal cancer-specific and all-cause survival	No association
Haas (2008)50	Isolation index	SEER-Medicare (1992–2002)	47,866 White, Black, and Hispanic women with breast cancer aged 66–85 yrs	Breast cancer-specific and all-cause mortality	No association
Johnson (2016)52	Isolation index	GA Comprehensive Cancer Registry (2000–2009)	8,322 White and Black early-stage non-small cell lung cancer cases	Lung cancer mortality	+ (Blacks)	High segregation and high economic deprivation were associated with greater mortality among Blacks, but not among Whites
					NA (Whites)
Hayanga (2013)51	Dissimilarity index	SEER registry (2003–2007)	Black and White populations per US county	Race-specific lung cancer mortality rates by county	+ (Blacks)	Dissimilarity index was associated with greater lung cancer mortality for Blacks, but lower mortality for Whites
					— (Whites)
Hispanic neighborhood
Pruitt (2015)10	Location quotient	TX Cancer Registry (1995–2009)	109,749 Black, Hispanic, and White women with breast cancer aged 50+ yrs	Breast cancer-specific and all-cause mortality	+	Among all women, higher Hispanic segregation was associated with greater breast cancer-specific and greater all-cause mortality.
						In analyses stratified by patient race/ethnicity, greater segregation was not associated with greater mortality among Hispanics.
Bemanian (2017)11	Location quotient	WI Cancer Reporting System (2002–2011)	7,164 White, 940 Black, and 252 Hispanic women with breast cancer	Breast cancer-specific and all-cause mortality	+	Local Hispanic isolation was associated with greater overall mortality for all women.
	Local exposure & isolation (Lex/Is)
	Index of concentration at extremes (ICE)
Haas (2008)50	Isolation index	SEER-Medicare (1992–2002)	47,866 White, Black, and Hispanic women with breast cancer aged 66–85 yrs	Breast cancer-specific and all-cause mortality	No association
Pruitt (2016)53	% Hispanic	TX Cancer Registry (1995–2009)	166,254 NHW and Hispanic women with breast cancer	Breast cancer- specific and all-cause mortality	+	Residing in higher Hispanic density neighborhoods was generally associated with higher all-cause and breast cancer-specific mortality, although associations differed slightly by ethnicity and birthplace.
Lim (2011)49	% Black	Los Angeles County Cancer Registry (1997- 2003)	1811 women with cervical cancer	Cervical cancer-specific mortality	No association
	% Hispanic
	% Asian
Keegan (2010)15	Enclave index	CA Cancer Registry (1988 – 2005)	37,695 Hispanic women with breast cancer	Breast cancer-specific and all-cause mortality	No association
Banegas (2014)54	Enclave index	CA Cancer Registry (2005–2010)	16,380 Hispanic women with breast cancer	Breast cancer-specific and all-cause mortality	No association
Patel (2013)55	Enclave index	CA Cancer Registry (1998–2007)	14,280 NHWs and Hispanics with lung cancer	Lung cancer-specific and all-cause mortality	Birthplace × enclave interaction	The association between birthplace and survival differed by enclave residence, with a protective effect of foreign-birth observed only among cases living in high enclave/low SES neighborhoods
Schupp (2014)56	Enclave index	CA Cancer Registry (1996–2004)	35,427 Hispanic men with prostate cancer	Prostate cancer-specific survival	Birthplace × enclave interaction	Foreign-born Hispanics had significantly better survival, but ethnic enclave modified this effect, with the survival advantage being more pronounced in the high enclave compared with low enclave neighborhoods.
Gomez (2015)14	Enclave index	CA Cancer Registry (1994–2009)	7958 Hispanic women with cervical cancer	Cervical cancer-specific mortality	Birthplace × enclave interaction	The association between birthplace and survival differed by enclave residence, with a protective effect of foreign-birth observed only among cases living in high enclave settings.
Asian neighborhood
Gomez (2010)57	Enclave index	CA Cancer Registry (1988 – 2005)	20,747 Asian women with breast cancer	Breast cancer-specific and all-cause mortality	No association
Lim (2011)49	% Black	Los Angeles County Cancer Registry (1997- 2003)	1811 women with cervical cancer	Cervical cancer-specific mortality	No association
	% Hispanic
	% Asian
Unspecified neighborhood
Keegan (2014)58	% Immigrant	Neighborhoods and Breast Cancer Study (NABC), northern CA	4,345 women with breast cancer	Breast cancer- specific and all-cause mortality	—	Residing in neighborhoods with more foreign-born residents was associated with lower breast cancer-specific mortality.

Note:

^aIn this column, we use “+” to indicate findings in which greater ethnic density was associated with higher mortality, whereas “—” is used to denote findings in which greater ethnic density was associated with lower mortality.