Differences in Cancer and All-Cause Mortality among Non-Hispanic Black American Adults by Nativity and Duration of Residence in the United States.

Background: Non-Hispanic Black (NHB) Americans bear a high burden of cancer and all-cause mortality. Previous studies show that foreign-born individuals in the United States generally have lower cancer mortality rates, although it is more pronounced among NHBs. This study examined differences in cancer and all-cause mortality risk between US-born and foreign-born NHB adults and by the duration of US residence among foreign-born individuals.

Methods: We used pooled data from the 1997 to 2018 National Health Interview Survey linked to the National Death Index with follow-up through December 31, 2019, including 90,487 NHB adults. Cox regression models were used to estimate adjusted HRs (aHR) by place of birth and duration of US residence, adjusting for sociodemographic and health behavior variables.

Results: Among participants (61.1% women, mean age 46.5), 90.6% were US-born, with an average follow-up of 10.9 years. US-born individuals had higher cancer mortality than foreign-born individuals [women: aHR = 1.78, 95% confidence interval (CI), 1.30-2.44; men: aHR = 1.39, 95% CI, 1.04-1.85]. For all-cause mortality, US-born individuals had similarly increased risks (women: aHR = 1.89, 95% CI, 1.60-2.23; men: aHR = 1.68, 95% CI, 1.44-1.96). No significant differences were observed based on the duration of US residence.

Conclusions: Intraracial disparity in cancer mortality has been continuously observed among NHBs by nativity. Multipronged research strategies are needed to understand this gap and develop appropriate interventions to address it.

Impact: Understanding nativity-based differences can inform strategies to reduce cancer outcome disparities faced by NHBs.