Chinese enclave protections among married Chinese American women: exploratory secondary analysis of colon cancer survival

ABSTRACT

Objective: Like the barrio advantage theory related to Mexican Americans, a theory about the protective effects of Chinese American enclaves is developing. Such protections were examined among socioeconomically vulnerable people with colon cancer.

Design: A colon cancer cohort established in California between 1995 and 2000, and followed until the enactment of the Affordable Care Act was utilized in this study. Secondary analysis was conducted on the 5-year survival among 127 Chinese Americans and 4524 other Americans (3810 non-Hispanic white and 714 Hispanic people). A third of the original cohort was selected from high poverty neighborhoods. Chinese American enclaves were neighborhoods where typically 25% or more of the residents were Chinese Americans. Effects were tested with Cox regressions and group differences described with age and stage-standardized survival rate ratios (RR).

Results: Though they were less adequately insured, Chinese American women residing in Chinese American enclaves (63%) were more likely to survive than were other Americans (50%, RR = 1.26). The protective effect of being married was also larger for Chinese Americans (RR = 1.31) than for others (RR = 1.17). Chinese American women (61%) were more likely than men (46%) to live in such enclaves and a large enclave survival advantage was observed among Chinese American women only (RR = 1.59).

Conclusions: There is consistent evidence of the relatively protected status of Chinese American women, particularly those who were married and resided in Chinese American enclaves. Mechanisms that explain their apparent advantages are not yet well understood, though relatively large, kin-based social networks seem instrumental. Research on the influence of social networks as well as the possible effects of acculturation is needed. This study also exposed structural inequities related to the institutions of marriage, health care and communities that disadvantage others. Policy makers ought to be aware of them as future reforms of American health care are considered.

KEYWORDS:

• Asian American
• Chinese American
• colon cancer
• ethnic enclave
• ethnicity
• gender
• health care reform
• health insurance
• marriage
• poverty
• race
• survival

Acknowledgements

We acknowledge the administrative assistance of Kurt Snipes, Janet Bates and Gretchen Agha of the Cancer Surveillance and Research Branch, California Department of Public Health (CDPH) and Dee West and Marta Induni of the Cancer Registry of Greater California (CRGC). We also acknowledge the research or technical assistance of Glen Halvorson, Donald Fong and Arti Parikh-Patel of the CRGC and Madhan Balagurusamy, Daniel Edelstein and Nancy Richter of the University of Windsor. Finally, we acknowledge the assistance of Isaac Luginaah and Guangyong Zou of Western University, Eric Holowaty of the University of Toronto, Emma Bartfay of the University of Ontario Institute of Technology, Caroline Hamm and Sindu Kanjeekal of Windsor’s Regional Cancer Center and Frances Wright of the Sunnybrook Health Sciences Center in obtaining funding or designing the database for this secondary analysis.

The collection of cancer incidence data used in this study was supported by the CDPH as part of the statewide cancer reporting program mandated by California Health and Safety Code; the National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Results Program under contracts awarded to the Cancer Prevention Institute of California, the University of Southern California, the Public Health Institute and the Centers for Disease Control and Prevention’s (CDCP) National Program of Cancer Registries under an agreement awarded to the CDPH. The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, the CDPH, the NCI or the CDCP or their contractors and subcontractors are not intended or should be inferred.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research [grant number 67161-2] and Ontario Graduate Scholarship.