Poor Neighborhoods Linked to Higher Digestive Cancer Deaths in Asian American and Pacific Islander Californians

Where a person lives may shape whether they survive a gastrointestinal cancer. A new population-based study of more than 5,100 cancer deaths among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) residents of California has found that people who lived in the state’s most economically disadvantaged neighborhoods died of gastrointestinal tract cancers at substantially higher rates than those from the wealthiest areas. The research, published in Cancer Causes & Control, provides some of the first evidence that neighborhood socioeconomic status—a composite measure of income, education, occupation, and housing conditions in a census tract—is linked to mortality across the full spectrum of digestive tract malignancies in these rapidly growing and highly diverse populations.

Gastrointestinal cancers, which arise in the esophagus, stomach, small intestine, colorectum, and anus, collectively represent the most common group of cancers in the United States and the second leading cause of cancer death nationwide, accounting for roughly 24 percent of all cancer mortality. Individual-level socioeconomic disadvantage has long been tied to worse outcomes in these cancers, including higher incidence, lower treatment rates, and poorer survival. But neighborhood-level socioeconomic status operates through a different set of mechanisms: it shapes access to screening facilities, the availability of specialists, transportation infrastructure, environmental exposures, and the linguistic and cultural resources of a community. For AANHPI populations, whose neighborhoods often reflect distinct immigration histories and settlement patterns, these contextual effects had never been systematically examined across gastrointestinal cancer sites.

The research team, led by investigators at Touro University California and the University of California, San Francisco, drew on the California Cancer Registry, a population-based registry that is part of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program and captures nearly every cancer diagnosis in the state by law. The researchers identified all non-Hispanic AANHPI men and women who died of cancers of the colorectum, stomach, esophagus, small intestine, or anus between January 2008 and December 2012. Cancers of the pancreas, liver, and gallbladder were deliberately excluded because these malignancies differ in anatomy, biology, risk factors, and screening pathways from the tubular gastrointestinal tract cancers, which share common dietary exposures and rely heavily on endoscopic diagnosis and surveillance.

To quantify neighborhood disadvantage, the team geocoded each patient’s residential address at diagnosis to a census tract and linked it to the California Neighborhoods Data System. Neighborhood socioeconomic status was measured using a composite index derived from American Community Survey data through factor analysis, incorporating median household income, median house value, median rent, the percentage of residents below 150 percent of the federal poverty line, an education index, the percentage of working-class residents, and unemployment. Each tract received a score, and tracts were ranked into five statewide quintiles, from the most disadvantaged (quintile 1) to the most affluent (quintile 5). Mortality rates were age-adjusted by the direct method and standardized to the 2000 U.S. Standard Population, with mortality rate ratios calculated against the highest quintile as the reference group.

The final cohort comprised 5,153 AANHPI individuals who died of gastrointestinal cancers during the five-year window. Colorectal cancer dominated the death toll, accounting for 59 percent of cases, followed by stomach cancer at 31 percent and esophageal cancer at 8 percent, with small intestine and anal cancers making up the remainder. Just over half of the deaths occurred in men, and most decedents were elderly, with 24 percent dying between ages 70 and 79 and 32 percent at age 80 or older. The overall picture that emerged was stark: AANHPI residents of the lowest neighborhood socioeconomic quintile had a 1.31-fold higher mortality rate for gastrointestinal cancers overall compared with those in the highest quintile, a difference that was highly statistically significant.

The gradient was even more pronounced among men. Males living in the poorest neighborhoods experienced gastrointestinal cancer mortality rates 50 percent higher than males in the wealthiest areas, with a mortality rate ratio of 1.50. Among women, the direction of the association was the same but weaker and did not reach statistical significance, with a mortality rate ratio of 1.11. The authors note that this sex difference could partly reflect the smaller number of female cases and reduced statistical power, but they also point to possible true differences in health-seeking behavior, screening uptake, comorbidity burden, and access to timely treatment. Prior national analyses have similarly found stronger links between area deprivation and cancer mortality in men than in women, and one study of Chinese American women found a colon cancer survival advantage among those living in ethnic enclaves that was absent in men, suggesting that social support networks may buffer some effects of neighborhood disadvantage for women.

Site-specific analyses reinforced the pattern. For colorectal cancer, the mortality rate ratio comparing the lowest with the highest neighborhood quintile was 1.37, and colorectal cancer showed the most consistent socioeconomic gradient, with significantly elevated mortality across all lower quintiles relative to the highest. Stomach cancer mortality was 1.23 times higher in the poorest neighborhoods, and esophageal cancer showed the single largest disparity at 1.47 times higher, though the latter estimate carried wider confidence intervals because of the smaller number of esophageal deaths. These findings extend to stomach and esophageal cancers a socioeconomic gradient that had previously been documented mainly for colorectal cancer, and they align with earlier SEER-based work showing that AANHPI colorectal cancer patients in the lowest neighborhood quintile had significantly higher cancer-specific mortality than those in the highest.

The mechanisms behind these disparities are likely multifactorial, but the study points strongly toward differential access to screening and early detection. Colorectal cancer screening is well established to reduce colorectal cancer mortality, and the 2009 California Health Interview Survey cited in the paper found that AANHPI individuals living below the federal poverty level had a colorectal cancer screening compliance rate of just 10.9 percent, compared with 57.7 percent among those at 300 percent of the poverty level or above. Barriers in low-income neighborhoods likely include lack of insurance, reduced availability of primary and specialty care, logistical and economic constraints, lower health literacy, and language and navigation difficulties. For stomach cancer, disparities may additionally reflect differences in the prevalence and management of Helicobacter pylori infection and early-life exposures, while esophageal cancer disparities may involve delayed diagnosis due to limited access to endoscopy and specialized oncology care.

The study has important limitations that the authors acknowledge candidly. The analysis relied on data from 2008 through 2012, chosen because the 2010 Census provided the most recent tract-level population denominators available for the neighborhood index, and population growth among AANHPI communities since then may have introduced some imprecision in the mortality rate calculations. The researchers could not disaggregate the broad AANHPI category into specific ethnic subgroups, could not adjust for individual-level socioeconomic status, lacked information on tumor stage, grade, and treatment, and could not distinguish urban from rural residence. Small numbers of small intestine and anal cancer deaths precluded subgroup analysis for those sites. Despite these constraints, the consistency of the findings across cancer sites and their agreement with prior studies suggest a genuine socioeconomic gradient in gastrointestinal cancer outcomes.

The implications reach well beyond California. AANHPI populations are among the fastest growing in the United States, having expanded by roughly 40 percent and 30 percent respectively between 2000 and 2010, and colorectal cancer is now the third most common cancer diagnosis in both AANHPI men and women, with most cases detected at advanced stages. Gastric cancer and esophageal squamous cell carcinoma mortality rates are also significantly higher in AANHPI populations than in non-Hispanic Whites, making the socioeconomic gradient documented here a matter of pressing public health concern. The authors call for future research to identify the specific social and built-environment factors—access to gastroenterology and oncology services, transportation infrastructure, linguistic isolation, housing instability, and environmental stressors—that drive these mortality gaps, and to clarify how sex interacts with neighborhood context. A deeper understanding of these pathways, they argue, will be essential for designing targeted interventions that reduce preventable deaths and promote equitable cancer outcomes in these diverse communities.

Subject of Research: Neighborhood socioeconomic disparities in gastrointestinal cancer mortality among Asian American, Native Hawaiian, and Pacific Islander populations in California

Article Title: Neighborhood socioeconomic status in relation to mortality rates of gastrointestinal cancers among Asian American, Native Hawaiian, and Pacific Islander populations in California

Article References: Lui, A., McKinley, M., Sanku, A., Wang, M., Lugue, M., Ngo, K., Van Blarigan, E. L., & Cheng, I. (2026). Neighborhood socioeconomic status in relation to mortality rates of gastrointestinal cancers among Asian American, Native Hawaiian, and Pacific Islander populations in California. Cancer Causes & Control, 37(10), Article 176. https://doi.org/10.1007/s10552-026-02261-x

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02261-x

Keywords: gastrointestinal cancer, neighborhood socioeconomic status, AANHPI populations, cancer mortality, colorectal cancer, stomach cancer, esophageal cancer, health disparities, California Cancer Registry, cancer screening, social determinants of health, epidemiology