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Original Investigation
June 2016

Risk of Childhood Cancer by Maternal BirthplaceA Test of the Hispanic Paradox

Author Affiliations
  • 1Department of Epidemiology, Fielding School of Public Health, University of California–Los Angeles
  • 2Division of Pediatric Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine University of California–Los Angeles
  • 3Veterans Affairs Greater Los Angeles, Los Angeles, California
  • 4Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Pediatr. 2016;170(6):585-592. doi:10.1001/jamapediatrics.2016.0097

Importance  The Hispanic epidemiologic paradox is the phenomenon that non-US–born Hispanic mothers who immigrate to the United States have better pregnancy outcomes than their US-born counterparts. It is unknown whether this advantage extends to childhood cancer risk.

Objective  To determine whether the risk for childhood cancers among Hispanic children varies by maternal birthplace.

Design, Setting, and Participants  In this population-based case-control study conducted in June 2015, cohort members were identified through California birth records of children born in California from January 1, 1983, to December 31, 2011. Information on cancer diagnoses was obtained from California Cancer Registry records from 1988 to 2012. Cases (n = 13 666) were identified from among children younger than 6 years in the California Cancer Registry and matched to California birth certificates. Control children (n = 15 513 718) included all other children born in California during the same period. Maternal birthplace and ethnic ancestry were identified from the birth certificate.

Main Exposures  Maternal race/ethnicity and birthplace.

Main Outcomes and Measures  We used Cox proportional hazards modeling to estimate hazard ratios (HRs) of childhood cancer.

Results  Included in the study were 4 246 295 children of non-Hispanic white mothers (51.3% male), 2 548 822 children of US-born Hispanic mothers (51.0% male), and 4 397 703 children of non-US–born Hispanic mothers (51.0% male). Compared with children of non-Hispanic white mothers, the children of non-US–born Hispanic mothers had a reduced risk for glioma (HR, 0.50; 95% CI, 0.44-0.58), astrocytoma (HR, 0.43; 95% CI, 0.36-0.51), neuroblastoma (HR, 0.47; 95% CI, 0.40-0.54), and Wilms tumor (HR, 0.70; 95% CI, 0.59-0.82). For these cancer types, the risk estimates for children of US-born Hispanic mothers fell between those of the children of US-born white and non-US–born Hispanic mothers. Children of Mexican-born mothers had a higher risk of yolk sac tumors (HR, 1.46; 95% CI, 0.99-2.17), while children of US-born Hispanic mothers with ancestry from countries other than Mexico had a higher risk for unilateral retinoblastoma (HR, 2.03; 95% CI, 1.33-3.11).

Conclusions and Relevance  For several cancers, we observed differential risk by maternal place of birth. Examining the differences in health behaviors and environment between Hispanic groups may shed light on childhood cancer etiology.