Premigration Harm and Depression: Findings from the New Immigrant Survey, 2003

Studies examining refugees from conflict areas have found that persecution in the place of origin is a risk factor for depression. No studies have looked at this association between mental health and the experience of premigration harm due to race, gender or religion in the general population of United States immigrants. The New Immigrant Survey baseline questionnaire was administered to a random sample of adults receiving legal permanent residency in the U.S. in 2003 (n = 8,573), including refugees, asylees and other immigrants. In multivariate analysis controlling for visa type, premigration harm was a predictor of general depression of borderline statistical significance [odds ratio (OR), 1.33; 95 % CI 0.98–1.80, p = 0.068] and a significant predictor of major depression with dysphoria (OR, 2.24; 95 % CI 1.48–3.38, p = 0.0001). These findings suggest that premigration harm is a risk factor for depression in the general immigrant population and not just among refugees.     

Cross-sectional associations between 24-h movement guideline adherence and suicidal thoughts among Canadian post-secondary students

Suicide is one of the leading causes of death among post-secondary students. It is, therefore, imperative that we identify behavioral risk factors that can have protective effects in preventing against suicide. This study examined whether different combinations of adherence to the Canadian 24-Hour Movement Guidelines for Adults (i.e., physical activity, sedentary behavior, sleep) were associated with reduced odds of suicidal ideation and planning among emerging adults attending post-secondary education. This cross-sectional observational study used data from the first cycle of the Canadian Campus Wellbeing Survey, which included a total of 17,633 students (Mean age = 21.7 ± 2.92 years; 67.1% female, 31.5% male, 1.4% other) enrolled in 20 Canadian post-secondary institutions. Logistic regression models with covariate balanced propensity score weighting were computed. Suicidal ideation and suicidal planning were reported by 14.4% and 4.9% of students, respectively. Adherence to the sleep (OR = 0.71; 95% CI: 0.58–0.86), physical activity and sleep (OR = 0.74; 95% CI: 0.62–0.88), sedentary behavior and sleep guidelines (OR = 0.64; 95% CI: 0.45–0.90) as well as concurrent adherence to all three guidelines (OR = 0.58; 95% CI: 0.44–0.75) were associated with significantly reduced odds of suicidal ideation. Among students who reported suicidal ideation, only adherence to the physical activity and sleep guidelines (OR = 0.67; 95% CI: 0.48–0.96) was associated with suicidal planning. Collectively, findings suggest the promotion of healthy movement behavior patterns may be a promising avenue for broad suicide and mental health prevention efforts on campus, although the potency of these effects may not extend to more severe suicidal thoughts.     

Comparing Pregnancy Outcomes of Immigrants from Ethiopia and the Former Soviet Union to Israel,to those of Native-Born Israelis

To compare pregnancy outcomes of immigrants from Former-Soviet-Union (FSUI) and Ethiopia (EI) to those of Jewish-native-born Israelis (JNB), in context of universal health insurance. Birth outcomes of all singletons born in Soroka-University Medical-Center (1998–2011) of EI (n = 1,667) and FSUI (n = 12,920) were compared with those of JNB (n = 63,405). Low birthweight rate was significantly higher among EI (11.0 %) and slightly lower (7.0 %) among FSUI, compared to JNB (7.5 %). Preterm-delivery rates were similar to those of JNB. Both immigrant groups had significantly (p < 0.001) higher rates of perinatal mortality (PM) than JNB (21/1000 in EI, and 11/1000 in FSUI, compared to 9/1000). Using multivariable GEE models both immigrant groups had significantly increased risk for PM; however, EI had twice as much FSUI origin (OR 2.3, 95 % CI 1.6–3.4, and OR 1.3, 95 % CI 1.1–1.6, respectively). Universal health care insurance does not eliminate excess PM in immigrants, nor the gaps between immigrant groups.     

Linear growth in early life is associated with suicidal ideation in 18-year-old Filipinos

Studies in Western societies have shown some evidence that growth in early life may be associated with suicide and suicidal ideation in later life. The pattern of growth retardation in developing countries is different from that in Western societies. This study examines the association between size at birth, postnatal growth from birth to age 24 months and suicidal ideation in 18-year-old Filipinos. The 1941 participants born in 1983 and 1984 in the Philippines were assessed for growth status bimonthly from birth to 24 months of age and were administered an interview in 2002, which included items on suicidal ideation.
The pattern of growth stunting in this cohort was similar to that in many other developing countries: a minor level of shortness in crown-heel length at birth followed by sharp decline in length-for-age in the first 24 months of life. The prevalence of suicidal ideation at age 18 was 2.9%; 95% confidence interval [CI] 2.2, 3.8%. Length Z-score at 24 months (odds ratios [OR] = 0.67; 95% CI [0.52, 0.86]; P  = 0.002) and gain in length Z-score from birth to age 24 months (OR = 0.74; 95% CI [0.56, 0.98]; P  = 0.037) were inversely associated with the odds of suicidal ideation. Adjustment for covariates made little difference. Length at birth Z-score was associated with suicidal ideation only after adjustment for postnatal length gain (OR = 0.61; 95% CI [0.46, 0.80]; P  < 0.001). The associations between linear growth in early life and suicidal ideation appeared to be partly mediated by educational attainment. In conclusion, postnatal growth stunting is an important predictor of suicidal ideation in later life. It also affects the association between birth length and suicidal ideation.     

Association between perceived security of the neighbourhood and small-for-gestational-age birth

Evidence points to an association between a mother's place of residence and her newborn's health, independent of individual characteristics. Neighbourhood constructs such as immigrant density, deprivation and crime have all been separately associated with birth outcomes. Little research has considered the joint influence of variables representing a spectrum of neighbourhood constructs. Subjective vs. objective measures of neighbourhood constructs (e.g. reported vs. perceived crime) are often not considered. We sought to evaluate the relationship between neighbourhood measures of reported crime, neighbourhood perceived security, immigrant density, material/social deprivation, residential stability and the odds of small-for-gestational-age (SGA) birth in an urban setting in Canada. Neighbourhood was defined as police districts ( n  = 49). We linked Montreal livebirths 1997–2001 ( n  = 98 330) to police district crime measures, survey data on perceived security, and 2001 census data. We used multi-level analysis to calculate odds ratios (OR) for neighbourhood effects on SGA birth accounting for individual characteristics.
Mothers residing in neighbourhoods with the most favourable perception had a lower odds of SGA birth than neighbourhoods with the least favourable perception [OR 0.87, 95% CI 0.77, 0.97]. Mothers in neighbourhoods with lower proportions of immigrants had lower odds of SGA birth relative to neighbourhoods with the highest proportion of immigrants. Reported crime, residential stability and material/social deprivation (accounting for neighbourhood perception) were not associated with SGA birth. Immigrant density and subjective perceptions of neighbourhood security are associated with SGA birth. Public health strategies to improve fetal growth should target neighbourhoods with low perceived security and high immigrant density.     

Chronic Physical Illness Burden and Suicidal Ideation Among Dominicans in New York City

Little is known about the association between chronic illness and suicidal ideation (SI) among Dominicans living in the United States. This study used data from a community survey of 2753 Dominican adults in New York City. SI included thoughts of self-harm or being better off dead in the past month. Chronic physical illness burden was categorized as having 0, 1, or 2+ diagnosed conditions. Adjusted logistic regressions evaluated the association between number of conditions and SI, overall and stratified by sex and age. Adjusted models yielded a strong association between chronic illness burden and SI among men [odds ratio (OR) 5.57, 95 % confidence interval (CI) 2.19–14.18] but not women (OR 0.80, 95 % CI 0.50–1.29; interaction p = 0.011). The association of interest did not differ significantly between younger and older adults. Screening for SI in health care practice, particularly among Dominican men with multiple chronic health conditions, may be warranted.     

Gestational Weight Gain,Body Mass Index,and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population

Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46–10.00; p_trend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00–8.71, p_trend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34–2.27) and 1.86 odds of preeclampsia (95 % CI 1.37–2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.     

Rate of Cervical Cancer Screening Associated with Immigration Status and Number of Years Since Immigration in Ontario, Canada

Cervical cancer screening is a vital public health measure intended to reduce the morbidity and mortality from what is a largely preventable cancer. Previous Canadian studies have documented that immigrants have significantly lower Papanicolaou (Pap) testing rates than women born in Canada. However, the impact of number of years since immigration is less clear. Data were taken from the 2007–2008 Canadian Community Health Survey. Responses from 16, 706 women living in Ontario, Canada were included. The focus was on self-reported Pap testing rates within the last 3 years, immigrant status and number of years since immigration. A robust Poisson regression model was used to determine prevalence ratios (PR) with 95 % confidence intervals (CIs) after adjustment for covariates. The results demonstrated that recent immigrant women (less than 10 years in Canada) were less likely to have had a Pap test in the past 3 years than those who were Canadian-born (PR = 0.77; 95 % CI: 0.71, 0.84). In contrast, immigrants who had lived in Canada for 10 years or longer showed similar compliance with recommended Pap testing intervals as non-immigrants. Higher income, higher level of education, younger age and being married were independently associated with better Pap testing rates. A strategy targeting recent immigrants to Canada is needed to promote Pap testing in this population and reduce their risk of invasive cervical cancer.     

Healthcare Utilization Among Hispanic Immigrants with Diabetes: Investigating the Effect of US Documentation Status

Previous studies have not examined whether documentation status has an effect on healthcare utilization among US Hispanic immigrants with diabetes. A secondary analysis was conducted using data from the Pew Hispanic Center and Robert Johnson Wood Foundation’s 2007 Hispanic Healthcare Survey. Hispanic immigrants diagnosed with diabetes were included in analyses. The association between documentation status and healthcare utilization was assessed using logistic regressions. Of N = 577 Hispanic immigrants with diabetes, 80 % were documented immigrants and 81 % reported having visited a healthcare provider in the last 6 months. Adjusting for confounders, those who were undocumented faced higher odds of having seen a healthcare provider more than 6 months ago or never when compared to those who were documented (OR = 1.79; 95 % CI 1.01, 3.14). Unique opportunities in addressing healthcare disparities can be found in focusing on the Hispanic immigrant population living with diabetes.     

The Relationship of Language Acculturation (English Proficiency) to Current Self-Rated Health Among African Immigrant Adults

Although over 1.5 million African immigrants live in the US, few studies have examined the relationship of language acculturation to health outcomes among African immigrant adults. The primary objective of this research was to investigate the relationship between English proficiency and current self-rated health among African immigrant adults. Using a cross-sectional design, a secondary data analysis was performed on baseline data from the African immigrant adult subsample (n = 763) of the 2003 New Immigrant Survey, a longitudinal study of lawful permanent residents. Limited English proficiency (LEP), increased duration of US residence, older age at immigration, being male, less than 12 years of education, poor pre-migration health, and chronic disease were associated with good/fair/poor current self-rated health. Findings support consideration of pre-migration health and chronic disease in future acculturation and health studies, and provision of linguistically competent interventions for LEP African immigrants at risk for poor health outcomes.     

Substance Use,Age at Migration,and Length of Residence Among Adult Immigrants in the United States

In this study we scrutinize prevalence of current smoking and binge drinking among adult US immigrants, and examine whether age at migration predicts these two behaviors and moderates the effect of length of residence. Immigrant groups include those from Latin America/Caribbean, East and South Asia, Sub-Saharan Africa, Europe/Central Asia, and Middle East/North Africa. Multivariate logistic regressions are estimated using cross-sectional data from the New Immigrant Survey (N = 7,397). Results show that patterns of smoking and binge drinking vary by gender and by region of origins. In addition, arriving at age 0–9 are directly associated with higher odds of binge drinking among adult women. Among adult men, age at migration moderates the association between length of residence and substance use. Specifically, length of residence has more detrimental effects for adolescent immigrants (arriving at age 10–18) on smoking, while its detrimental effects are more pronounced for childhood immigrants (arriving at age 0–9) on binge drinking. We interpret our findings within the critical period model in epidemiological research, concluding that adolescence and childhood are critical life stages that are associated with differential effects of length of residence when looking at smoking and binge drinking among immigrant men.     

Relationship Between Current Sleep Duration and Past Suicidal Ideation or Attempt Among Korean Adolescents

Objectives

To comprehensively examine the relationship between current sleep duration and past suicidal idea or attempt among Korean adolescents.

Methods

Data came from the 2009 Korea Youth Risk Behavior Web-based Survey with 75 066 participants (with the participation rate of 97.6%) in 800 middle and high schools. Binary logistic regression was conducted by gender and depressed mood to identify significant factors for suicidal ideation/attempt. The dependent variable was the log odds of suicidal ideation/attempt, while the independent/control variables were sleep duration and other demographic, socio-economic and health-related factors.

Results

A negative association between sleep duration and suicidal ideation or attempt was weaker for those with depressed mood than for those without such experience in Korea for Year 2009. The odds ratio of suicidal ideation/attempt regarding less than 4 hours of sleep compared to 6 to 7 hours of sleep, was smaller in a group with depressed mood than in a group without such experience, for example, 1.64 (95% confidence interval [CI], 1.29 to 2.08) vs. 2.06 (95% CI, 1.34 to 3.17) for men''s suicidal ideation, 2.50 (95% CI, 1.69 to 3.69) vs. 3.89 (95% CI, 1.74 to 8.66) for men''s suicidal attempt. A negative association between age (or self-rated health) and suicidal ideation/attempt was also weaker for those with depressed mood than for those without such experience in the nation for the year.

Conclusions

There was a negative association between sleep duration and suicidal ideation/attempt in Korea for Year 2009 and this association was weaker for those with depressed mood than for those without such experience. Based on the findings of this study, adolescents'' better mental health and longer, more comfortable sleep might help to prevent their suicidal ideation and attempt in Korea.     

Different Outcomes for Different Health Measures in Immigrants: Evidence from a Longitudinal Analysis of the National Population Health Survey (1994–2006)

The response of immigrants to new societies is dynamic. There may be an initial period of happiness followed by peaks of stressful periods. These reactions along with socio-economic changes are likely to influence their health, which may start converging towards the average health of the host population. We used a longitudinal analysis to assess the differences in health outcomes (mental health and self-rated health), separately in men and women, in Canadian born and immigrants over a 12-year period (and the associated socio-economic factors). We used random effects logistic regression models for evaluation of these health outcomes in 3,081 men and 4,187 women from the National Population Health Survey (1994/95 to 2006/07). After adjusting for all the covariates, non-white immigrants were less likely to have severe psychological distress compared with the Canadian born individuals [odds ratio (OR) Men: 0.49, 95% confidence intervals (CI) 0.24–1.00, Women-OR: 0.54; 95% CI: 0.32–0.92]. Immigrant women (white and non-white) were more likely to rate their health as poor through this 12-year period than the Canadian born women (White-OR: 1.64, 95% CI: 1.17–2.64; Non-white-OR: 1.82, 95% CI: 1.01–3.28). Immigrants in the lowest income adequacy category reported higher psychological distress and poorer health than those in the highest income categories. We did not find any significant differences in the mental health and self-rated health of Canadian men and white male immigrants throughout this 12-year period. Though, non-white immigrant women were less likely to have severe psychological distress through this 12 year period, they were the ones most likely to rate their health as poor.     

Association of Child Marriage With Suicidal Thoughts and Attempts Among Adolescent Girls in Ethiopia

PurposeLittle information exists on the mental health implications of child marriage in Africa. This study examined the association between child marriage and suicidal ideation and suicide attempt among girls aged 10–17 years.MethodsData were drawn from a 2007 cross-sectional survey conducted in the Amhara region, Ethiopia. Multilevel logistic regression was used to analyze risk factors for suicidality.ResultsApproximately 5.2% of girls reported ever being married, 5.4% were promised in marriage, and 9.3% reported receiving marriage requests. Girls who were ever married (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.03–3.18), were promised in marriage (OR = 2.35; 95% CI = 1.38–4.01) or had received marriage requests (OR = 2.29; 95% CI = 1.46–3.59) were significantly more likely than girls who were never in the marriage process to have had suicidal thoughts in the past 3 months. Residence in communities with high involvement in stopping child marriage was protective of suicidal ideation. The odds of suicide attempt were twice as high among girls with marriage requests as among those with none.ConclusionsChild marriage was associated with increased odds of suicidality. Findings call for stronger community engagement in child marriage prevention and mental health support for child brides.     

The Association Between Acculturation and Cardiovascular Disease Risk in Ghanaian and Nigerian-born African Immigrants in the United States: The Afro-Cardiac Study

The burden of cardiovascular disease (CVD) risk in ethnic minorities in the United States (US) is high. Acculturation may worsen or improve cardiovascular health in immigrants. We sought to examine the association between acculturation and elevated cardiovascular disease risk in African immigrants, a growing immigrant population in the US. We conducted a cross-sectional study of Ghanaian and Nigerian born-African immigrants in the US. To determine whether acculturation was associated with having elevated CVD risk (defined as ≥3 CVD risk factors or Pooled Cohort Equations score ≥7.5%), we performed unadjusted and adjusted logistic regression analyses. For both outcomes, sex-specific models were fitted. Participants (N?=?253) were aged 35–74 years and resided in Baltimore–Washington-D.C. The mean age (SD) was 49.5 (9.2) years and 58% were female. Residing in the US for ≥10 years was associated with an almost fourfold (95% CI 1.05–14.35) and eightfold (95% CI 2.09–30.80) greater odds of overweight/obesity and elevated CVD risk respectively in males. Females residing in the US for ≥10 years had 2.60 times (95% CI 1.04–6.551) greater odds of hypertension than newer residents. Participants were classified according to acculturation strategies: Integrationists, 166 (66%); Traditionalists, 80 (32%); Marginalists, 5 (2%); and Assimilationists, 2 (1%). Integrationists had a 0.46 (95% CI 0.24–0.87) lower odds of having ≥3 CVD risk factors and 0.38 (95% CI 0.18–0.78) lower odds of having elevated CVD risk (Pooled Cohort Equations score ≥7.5%) than Traditionalists. Although longer length of stay was associated with CVD risk, Integrationists had lower CVD risk than Traditionalists. Our results suggest that coordinated public health responses to the epidemic of CVD risk factors in the US should target this understudied population. Acculturation should be considered as a meaningful contributor of increased CVD risk and acculturation strategies may be used to tailor interventions in African immigrants. Promoting successful integration may reduce immigrants’ CVD risk.     

Racism,Other Discriminations and Effects on Health

We study the probability of perceived racism/other forms of discrimination on immigrant and Spanish populations within different public spheres and show their effect on the health of immigrants using a cross-sectional design (ENS-06). Variables: perceived racism/other forms of discrimination (exposure), socio-demographic (explicative), health indicators (dependent). Frequencies, prevalences, and bivariate/multivariate analysis were conducted separately for men (M) and women (W). We estimated the health problems attributable to racism through the population attributable proportion (PAP). Immigrants perceived more racism than Spaniards in workplace (OR_M = 48.1; 95 % CI 28.2–82.2), and receiving health care (OR_W = 48.3; 95 % CI 24.7–94.4). Racism and other forms of discrimination were associated with poor mental health (OR_M = 5.6; 95 % CI 3.9–8.2; OR_W = 7.3; 95 % CI 4.1–13.0) and injury (OR_W = 30.6; 95 % CI 13.6–68.7). It is attributed to perceived racism the 80.1 % of consumption of psychotropics (M), and to racism with other forms of discrimination the 52.3 % of cases of injury (W). Racism plays a role as a health determinant.     

Use of maternal health services: comparing refugee,immigrant and US-born populations

Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73–12.13) and immigrant (OR 2.21, 95 % CI 1.00–4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04–3.83] and immigrant [OR 2.79, 95 % CI 1.72–4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care.     

Immigrants’ Experiences of Maternity Care in Japan

Language and cultural differences can negatively impact immigrant women’s birth experience. However, little is known about their experiences in Japan’s highly homogenous culture. This cross-sectional study used survey data from a purposive sampling of immigrant women from 16 hospitals in several Japanese prefectures. Meeting the criteria and recruited to this study were 804 participants consisting of 236 immigrant women: Chinese (n = 83), Brazilian (n = 62), Filipino (n = 43), South Korean (n = 29) and from variety of English speaking nations (n = 19) and 568 Japanese women. The questionnaire was prepared in six languages: Japanese (kana syllables), Chinese, English, Korean, Portuguese, and Tagalog (Filipino). Associations among quality of maternity care, Japanese literacy level, loneliness and care satisfaction were explored using analysis of variance and multiple linear regression. The valid and reliable instruments used were Quality of Care for Pregnancy, Delivery and Postpartum Questionnaire, Rapid Estimate of Adult Literacy in Medicine Japanese version, the revised UCLA Loneliness Scale-Japanese version and Care satisfaction. Care was evaluated across prenatal, labor and delivery and post-partum periods. Immigrant women scored higher than Japanese women for both positive and negative aspects. When loneliness was strongly felt, care satisfaction was lower. Some competence of Japanese literacy was more likely to obstruct positive communication with healthcare providers, and was associated with loneliness. Immigrant women rated overall care as satisfactory. Japanese literacy decreased communication with healthcare providers, and was associated with loneliness presumably because some literacy unreasonably increased health care providers’ expectations of a higher level of communication.     

Acculturation Factors and Metabolic Syndrome Among Japanese-Brazilian Men in Japan: A Cross-Sectional Descriptive Study

This study examines the acculturation effects on metabolic syndrome (MetS), and its related factors, among immigrant Japanese-Brazilian men in Japan. Quantitative and qualitative approaches were utilized. In the quantitative study (n = 149), multiple logistic regression analyses estimated the impact of length of residence and arrival age on MetS. For the qualitative study, five focus group discussions were conducted with participants (n = 26) from the quantitative study sample. The oldest arrival age group was more likely to have MetS (OR, 95 % CI 4.41, 1.09–17.78) after adjusting for covariates; whereas, length of residence had no association with MetS. The oldest arrival age group, with shorter residence period, was also associated with increased MetS prevalence. Qualitative results identified participants’ Brazilian dietary habits as being potential risk factors for MetS. Japanese-Brazilian immigrant men with older arrival age in Japan were more likely to suffer from MetS, especially shortly after arrival.     

Availability of Healthcare Resources and Colorectal Cancer Outcomes Among Non-Hispanic White and Non-Hispanic Black Adults

This study aims to examine if access to healthcare, measured through the availability of medical resources at the neighborhood level, influences colorectal cancer (CRC) stage, treatment and survival using the Surveillance Epidemiology and Ends Result (SEER) dataset (November 2012), linked with the 2004 Area Resource File. A cross-sectional study was conducted to determine the association between availability of healthcare resources and CRC outcomes among non-Hispanic Black (n = 9162) and non-Hispanic White patients (n = 97,264). CRC patients were identified using the SEER*Stat program, and individual socio-demographic, clinical, and county-level healthcare access variables were obtained for each patient. Among NH-W patients, residence in counties with lower number of oncology hospitals was associated with increased odds of late stage diagnosis (OR 1.09, 95 % CI 1.04–1.14), reduced odds of receiving surgery (OR 0.83, 95 % CI 0.74–0.92) and higher hazard rates (HR 1.09, 95 % CI 1.06–1.12). There were no significant associations among NH-B patients. Increased availability of healthcare resources improves CRC outcomes among NH-W patients. However, future studies are required to better understand healthcare utilization patterns in NH-B neighborhoods, and identify other important dimensions of healthcare access such as affordability, acceptability and accommodation.