To test the Hispanic and Immigrant Paradoxes—i.e., survival advantages despite a worse risk factor profile—and the modifying role of neighborhood context, we examined associations between patient ethnicity, birthplace, neighborhood Hispanic density and neighborhood poverty among 166,254 female breast cancer patients diagnosed 1995–2009 in Texas, U.S. Of all, 79.9% were non-Hispanic White, 15.8% Hispanic U.S.-born, and 4.2% Hispanic foreign-born. We imputed birthplace for the 60.7% of Hispanics missing birthplace data using multiple imputation. Shared frailty Cox proportional hazard models (patients nested within census tracts) adjusted for age, diagnosis year, stage, grade, histology, urban/rural residence, and local mammography capacity. Whites (vs. U.S.-born Hispanics) had increased all-cause and breast cancer mortality. Foreign-born (vs. U.S.-born) Hispanics had increased all-cause and breast cancer mortality. Living in higher Hispanic density neighborhoods was generally associated with increased mortality, although associations differed slightly in magnitude and significance by ethnicity, birthplace, and neighborhood poverty. We found no evidence of an Immigrant Paradox and some evidence of a Hispanic Paradox where protective effects were limited to U.S.-born Hispanics. Contrary to prior studies, foreign birthplace and residence in higher Hispanic density neighborhoods were associated with increased mortality. More research on intersections between ethnicity, birthplace and neighborhood context are needed. © 2016 by the authors; licensee MDPI, Basel, Switzerland.

Hispanic Breast cancer neighborhoods disparities Survival Inequality Ethnic enclave Immigration poverty

urban area rural area immigrant breast cancer proportional hazards model cancer patient Proportional Hazards Models Caucasian demography poverty histology human epidemiology middle aged birthplace Ethnic Groups rural population statistics and numerical data ethnic group controlled study Aged cancer ethnology Hispanic Americans neighborhood Residence Characteristics United States Young Adult social status Breast Neoplasms migrant Hispanic Adolescent Mammography Humans Emigrants and Immigrants breast tumor female Aged, 80 and over very elderly risk factor Risk Factors cancer registry Latino people Article cancer mortality major clinical study adult European Continental Ancestry Group ethnicity frailty mortality Texas immigrant population