A New Statistical Method for Estimating Cancer Mortality Rates by Immigration Status

1. A New Statistical Method for Estimating Cancer Mortality Rates by Immigration Status Mandi Yu, PhD NCI/DCCPS/SRP June 12, 2019

2. Collaborators • National Cancer Institute: Dr. Rocky Feuer, Dr. Benmei Liu, and Dr. Li Zhu • University of California at Davis: Dr. Jiming Jiang • Information Management Services (IMS), Inc.: Mr. Todd Gibson, Mr. Steve Scoppa, and Mr. Joe Zou

3. Agenda • History and Background • Proposed Bias-corrected Estimators of Age-adjusted Rate • Illustrative Example – Comparing Cancer Mortality Rates between foreign-born Hispanics and US-born Hispanics • Impact on Related Cancer Statistics • Cancer Incidence Rate for small geographic areas • Hysterectomy-corrected Incidence Rate

4. William M. Haenszel (1910-1998) • Developed the first national system to track cancer cases and their possible causes, i.e. NCI’s SEER program. • Hankey, Benjamin (1997). "A conversation with William M. Haenszel". Stat Sci. - JNCI, 1961

5. Haenszel 1961 Study is the first report of age-adjusted mortality rates for whites born in foreign countries in the US Cancer Deaths in 1950 from 35 States in the US

6. Foreign-Born Population and Percentage of Total Population, for the United States: 1970 to 2010 Source: U.S. Census Bureau, Census of Population, 1970 to 2000, and the American Community Survey, 2010.

7. Numerator • For the first time, death counts were broken down by cancer cause and birth place • For only 35 states • Available from the National Office of Vital Statistics(NOVS), the predecessor of National Vital Statistics System (NVSS) • We evaluated death data for 1979-2015 • % of missing birthplace data <2% for most states and years • Exceptions: • Georgia in 2008 and 2009 (~60% and ~97% of missing) • New Jersey in 1989 and 1990 (~14% of missing) • Birth-place question was asked to everyone who is counted by the decennial census • 100% of population • After 2000, long-form census no longer exists and replaced by American Community Survey (ACS) • ACS starts from 2006 with ~2.5% sample annually • Sample records with bridged single race variable obtained from IPUMS program of Univ. of Minnesota • Only several demographic questions were asked to everyone • Birth-place question was moved to the long-form survey that is administered at the same time of the census • 5%~25% of population 1960 ~ 2000 1950 2006 + Denominator

8. Categories of Birth Place Data Collected • Numerator - Death count from Death Certificate • City and State for US-Born, Foreign Country • Denominator: Census surveys • State for US-born, Write out option for names of foreign countries

9. Category of Birth Place for Analysis • Both numerator and denominator are recoded in the same way for calculating rates • Recoded to Nativity according to US Census definition • US-born – Anyone who is a U.S. citizen at birth • Foreign born – Anyone who is not a U.S. citizen at birth • SEER have obtained permission from the NCHS to release mortality by nativity

10. Current Methods Used for Calculating Mortality Rates • Numerator (D): death count by cancer cause for estimating mortality rate • Denominator (N): Annual population size × number of years observed and is assumed fixed in variance estimation • Age-standardized Rate (ASR) = denote age standardization group

11. Population Estimates of Foreign-born Hispanics and US-born Hispanics, California, ACS 2010

12. Coefficient of Variation (CV) of Population Estimates of Foreign-born Hispanics and US-born Hispanics, California, ACS 2010 *CV=Population Estimate/Standard Error

13. Population Estimates of Foreign-born Hispanics and US-born Hispanics, New Mexico, ACS 2010

14. Coefficient of Variation (CV) of Population Estimates of Foreign-born Hispanics and US-born Hispanics, New Mexico, ACS 2010 *CV=Population Estimate/Standard Error

15. A Natural Rate Estimator – Simple Ratio Estimator (SRE) • , • D: death Count; • : ACS-based population. • , • denote age group. 1/mean(x)=0.001 ≥ Mean(1/x)=0.00104 • However, SRE estimator is upward biased, and size of bias increases as the precision of decreases.

16. Proposed Bias-Corrected Estimator (BCE) • We also derived the variance of that considers the sampling error in the denominators

17. Illustrative Example

18. All Cancer Cause Morality Rate among Hispanics-- California Foreign-born US-born

19. All Cancer Cause Morality Rate among Hispanics– New Mexico Foreign-born US-born

20. Broader Impact • Incidence rates for small geographic areas • Connecticut registry: Towns (~5000 populations) • Louisiana registry: Authorized by law to report Census tract level rates in 2017 • California registries: groups of tracts or census blocks • NCHS: Census tract level life expectancy statistics • More accurate rates corrected for hysterectomy • Hysterectomy eliminates women’s risk of developing cervical, uterine, ovaries etc. • Population estimates by hysterectomy status can be obtained form National Health Surveys, such as NHIS or BRFSS

21. Thank you!