Cancer mortality in ethnic South Asian migrants in England and Wales (1993-2003): patterns in the overall population and in first and subsequent generations

Methods for retrospectively improving race/ethnicity data quality: a scoping review

Improving race and ethnicity (hereafter, race/ethnicity) data quality is imperative to ensure underserved populations are represented in data sets used to identify health disparities and inform health care policy. We performed a scoping review of methods that retrospectively improve race/ethnicity classification in secondary data sets. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were conducted in the MEDLINE, Embase, and Web of Science Core Collection databases in July 2022. A total of 2 441 abstracts were dually screened, 453 full-text articles were reviewed, and 120 articles were included. Study characteristics were extracted and described in a narrative analysis. Six main method types for improving race/ethnicity data were identified: expert review (n = 9; 8%), name lists (n = 27, 23%), name algorithms (n = 55, 46%), machine learning (n = 14, 12%), data linkage (n = 9, 8%), and other (n = 6, 5%). The main racial/ethnic groups targeted for classification were Asian (n = 56, 47%) and White (n = 51, 43%). Some form of validation evaluation was included in 86 articles (72%). We discuss the strengths and limitations of different method types and potential harms of identified methods. Innovative methods are needed to better identify racial/ethnic subgroups and further validation studies. Accurately collecting and reporting disaggregated data by race/ethnicity are critical to address the systematic missingness of relevant demographic data that can erroneously guide policymaking and hinder the effectiveness of health care practices and intervention.

Is locally advanced head and neck cancer 'increasing' in the Netherlands? The paradox of absolute numbers, standardized incidence rates and proportional share

BACKGROUND

Several reports have indicated that locally advanced head and neck cancer (LAHNC) has increased in the past decade. However, incidence trends cannot be easily compared because slightly different definitions of LAHNC were used.

AIM

To investigate if the incidence of locally advanced disease (LAD) in the oral cavity, oropharynx, hypopharynx and larynx is indeed increasing over time, considering the growing and ageing population in the Netherlands.

PATIENTS AND METHODS

Data were obtained from the Netherlands Cancer Registry (NCR). Primary head and neck squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx diagnosed between 1989 and 2017 were included. Yearly numbers and European standardized incidence rates (ESRs) were reported by extent of disease. The annual percentage change (APC) over time in ESRs was calculated to assess trends.

RESULTS

Absolute numbers and ESRs of LAD increased over time for oral cavity and most prominently for oropharynx carcinomas (before 1996, APC: 0.4, 95%CI: 0.1; 0.8 and APC: 5.7 (95%CI: 3.1; 8.4) after 1996: 1.5 (1.0; 2.0) respectively. For hypopharynx cancer the absolute number and ESR of LAD increased until 1997 and declined with 0.8% per year since 1997. Absolute numbers of patients with larynx cancer stayed stable over time, while ESR decreased (APC: -0.8 (95%CI: -1.1; -0.6)).

CONCLUSION

The perception of an increasing trend in LAD in the Netherlands can be attributed to the increasing incidence of oral cavity and oropharynx carcinomas. For LAD of the hypopharynx a decreasing trend was observed. In larynx cancer, the proportional share of LAD of the larynx increased, even though incidence rates declined.

The Preventive Role of Hydrogen-Rich Water in Thioacetamide-Induced Cholangiofibrosis in Rat Assessed by Automated Histological Classification

Background: Cholangiofibrosis is a controversial intrahepatic cholangial lesion that precedes the development of cholangiocarcinoma. Here, we demonstrate that molecular hydrogen (H₂) can be used to effectively prevent cholangiofibrosis.

Methods: The safety and quality of life (QOL) of rats was firstly evaluated. H₂ was administered to rats subjected to thioacetamide (TAA)-induced cholangiofibrosis throughout the whole process. Then, rats were administrated with TAA for 3 months and then followed by H₂ intervention. Rat livers were harvested and assessed by light microscopy and convolutional neural network. RNA-seq was performed to analyze the genetic changes in these animal models.

Results: Continuous use of H₂-rich water was safe and improved QOL.The incidence and average number of cholangiofibrosis in the liver were higher in the TAA group (100%, 12.0 ± 10.07) than that in the H₂ group (57.1%, 2.86 ± 5.43). The AI algorithm revealed higher Alesion/Aliver in the TAA group (19.6% ± 9.01) than that in the H₂ group (7.54% ± 11.0). RNA-seq analysis revealed that H₂ results in a decline in glycolysis. Moreover, in the third experiment, the incidence of microscopic or suspicious tumors and the ratio of liver lesions was decreased after long-term use of H₂ (12.5%, 0.57% ± 0.45) compared with untreated group (100%, 0.98% ± 0.73). A number of intestinal microbiota was changed after H₂ usage, including clostridiaceae_1, ruminococcus, turicibacter, coriobacteriales, actinobacteria, and firmicutes_bacterium.

Conclusion: Hydrogen-rich water protects against liver injury and cholangiofibrosis and improved quality of life partially through regulating the composition of intestinal flora.

Chinese and South Asian ethnicity, immigration status and head and neck cancer outcomes: A population based study

OBJECTIVE

While it is known that certain ethnic and immigrant groups are at increased risk of developing head and neck cancer, the individual effects of immigration status and ethnicity on head and neck cancer outcomes is less clear. We sought examine the independent effects of immigration and Chinese and South Asian ethnicity on overall survival in a head and neck cancer patient population.

METHODS

This was a population-based retrospective matched cohort study using linked Ontario administrative databases between 1994 and 2017. Incident cancer cases were captured in long-standing residents of Chinese and South Asian ethnicity, Chinese and South Asian immigrants, as well as a reference population. Subjects were followed until death. A hard-matching approach was used to adjust for key differences and ensure both groups were balanced with respect to age, sex and cancer site. Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on overall survival while further adjusting for baseline covariates.

RESULTS

Among 1639 immigrants with head and neck cancer, matched to 3278 controls, the overall 5-year survival rate was 66% and 59%, respectively. After adjusting for between group-differences, all-cause mortality was lower for immigrants (HR 0.76[95%CI 0.69-0.83]) and individuals of Chinese ethnicity (HR 0.78[95%CI 0.68-0.90]), relative to the general population.

CONCLUSIONS

In Ontario, immigrants experience lower mortality rates following a head and neck cancer diagnosis. Individuals of Chinese ethnicity with head and neck cancer experience a survival advantage, relative to South Asian individuals and the general population.

Overrepresentation of South Asian ethnic groups among cases of influenza A(H1N1)pdm09 during the first phase of the 2009 pandemic in England

BACKGROUND

During the first wave of the influenza A(H1N1)pdm09 pandemic in England in 2009, morbidity and mortality were higher in patients of South Asian (Indian, Pakistani or Bangladeshi) ethnic minority groups.

OBJECTIVES

This study aims to provide insights in the representation of this group among reported cases, indicating susceptibility and exposure.

METHODS

All laboratory-confirmed cases including basic demographic and limited clinical information that were reported to the FluZone surveillance system between April and October 2009 were retrieved. Missing ethnicity data were imputed using the previously developed and validated South Asian Names and Group Recognition Algorithm (SANGRA). Differences between ethnic groups were calculated using chi-square, log-rank and t tests and rate ratios. Geographic clustering was compared using Ripley's K functions.

RESULTS

SANGRA identified 2447 (28%) of the total of 8748 reported cases as South Asian. South Asian cases were younger (P < .001), more often male (P = .002) and more often from deprived areas (P < .001) than cases of other ethnic groups. Time between onset of symptoms and laboratory sampling was longer in this group (P < .001), and they were less often advised antiviral treatment (P < .001), however, declined treatment less. The highest cumulative incidence was seen in the West Midlands region (32.7/10 000), London (7.0/10 000) and East of England region (5.7/10 000).

CONCLUSIONS

People of South Asian ethnic groups were disproportionally affected by the first wave of the influenza pandemic in England in 2009. The findings presented contribute to further understanding of demographic, socioeconomic and ethnic factors of the outbreak and inform future influenza preparedness to ensure appropriate prevention and care.

Low Cancer Risk of South Asians: A Brief Report

CONTEXT

South Asians (ancestry in India, Pakistan, Bangladesh, or Sri Lanka) may have lower cancer risk than other racial-ethnic groups.

OBJECTIVE

To supplement published cohort data suggesting low cancer risk in South Asians.

DESIGN

Logistic regression models with 7 covariates to study cancer mortality through 2012 in 273,843 persons (1117 South Asians) with baseline examination data from 1964 to 1985.

MAIN OUTCOME MEASURE

Cancer mortality.

RESULTS

Through 2012, death was attributed to cancer in 28,031 persons, of which 1555 were Asians, including 32 South Asians. The all-Asian vs white adjusted odds ratio was 1.0, and the South Asian vs white odds ratio was 0.5 (p < 0.001). In separate regressions, South Asians were at lower risk than blacks, Chinese, Filipinos, Japanese, or other Asians. The South Asian-white disparity was concentrated in men but was generally similar when strata of smoking, body mass index, baseline age, and date of death were compared.

CONCLUSION

These data support the observation that compared with whites and other Asian groups, South Asians, especially men, have a lower risk of cancer.

Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations

BACKGROUND

Although rare in the United States, gallbladder cancer (GBCA) is a common cause of cancer death in some parts of the world. To investigate regional differences in pathogenesis and outcomes for GBCA, tumor mutations were analyzed from a sampling of specimens.

METHODS

Primary tumors from patients with GBCA who were treated in Chile, Japan, and the United States between 1999 and 2016 underwent targeted sequencing of known cancer-associated genes. Fisher exact and Kruskal-Wallis tests assessed differences in clinicopathologic and genetic factors. Kaplan-Meier methods evaluated differences in overall survival from the time of surgery between mutations.

RESULTS

A total of 81 patients were included. Japanese patients (11 patients) were older (median age, 72 years [range, 54-81 years]) compared with patients from Chile (21 patients; median age, 59 years [range, 32-73 years]) and the United States (49 patients; median age, 66 years [range, 46-87 years]) (P = .002) and had more well-differentiated tumors (46% vs 0% for Chile/United States; P < .001) and fewer gallstone-associated cancers (36% vs 67% for Chile and 69% for the United States; P = .13). Japanese patients had a median mutation burden of 6 (range, 1-23) compared with Chile (median mutation burden, 7 [range, 3-20]) and the United States (median mutation burden, 4 [range, 0-27]) (P = .006). Tumors from Japanese patients lacked AT-rich interaction domain 1A (ARID1A) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations, whereas Chilean tumors lacked Erb-B2 receptor tyrosine kinase 3 (ERBB3) and AT-rich interaction domain 2 (ARID2) mutations. SMAD family member 4 (SMAD4) was found to be mutated similarly across centers (38% in Chile, 36% in Japan, and 27% in the United States; P = .68) and was univariately associated with worse overall survival (median, 10 months vs 25 months; P = .039). At least one potentially actionable gene was found to be altered in 80% of tumors.

CONCLUSIONS

Differences in clinicopathologic variables suggest the possibility of distinct GBCA pathogenesis in Japanese patients, which may be supported by differences in mutation pattern. Among all centers, SMAD4 mutations were detected in approximately one-third of patients and may represent a converging factor associated with worse survival. The majority of patients carried mutations in actionable gene targets, which may inform the design of future trials.

Differences in cancer survival between immigrants in Norway and the host population

Cancer survival is an important indicator for quality of cancer care. We sought to determine if there are differences in cancer survival between immigrants and the host population in Norway. We performed a nationwide registry-based study comprising subjects diagnosed with cancer between 1990 and 2014, and followed until the end of 2016. Survival was estimated for 13 cancer sites with cause-specific survival. Adjustments were made for common confounders (age, sex, year of diagnosis and place of residence) and defined mediators (stage at diagnosis, comorbidity and socioeconomic factors). A total of 500,255 subjects were available for analysis, of which 11,252 were Western and 8,701 non-Western immigrants. We did not find differences in cancer survival between Western immigrants and Norwegians, while non-Western immigrants, with some exceptions, had similar or better survival. Better lung cancer survival in non-Western immigrants than Norwegians was notable (hazard ratio (95% confidence interval): 0.78 (0.71-0.85)), and not explained by defined mediators. Immigrants from Eastern Europe and Balkan with melanoma (hazard ratio: 1.54 (1.12-2.12)) and prostate cancer (hazard ratio: 1.34 (1.08-1.67)), and possibly from sub-Saharan Africa with breast cancer (hazard ratio: 1.41 (0.94-2.12)) had worse survival than Norwegians. The results suggest that immigrants in Norway have good cancer survival relative to the host population. Poor survival in immigrants from Eastern Europe and Balkan with melanoma and prostate cancer, and sub-Saharan Africa with breast cancer might be a concern.

Ethnicity and excess mortality in severe mental illness: a cohort study

BACKGROUND

Excess mortality in severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders) is well described, but little is known about this inequality in ethnic minorities. We aimed to estimate excess mortality for people with severe mental illness for five ethnic groups (white British, black Caribbean, black African, south Asian, and Irish) and to assess the association of ethnicity with mortality risk.

METHODS

We conducted a longitudinal cohort study of individuals with a valid diagnosis of severe mental illness between Jan 1, 2007, and Dec 31, 2014, from the case registry of the South London and Maudsley Trust (London, UK). We linked mortality data from the UK Office for National Statistics for the general population in England and Wales to our cohort, and determined all-cause and cause-specific mortality by ethnicity, standardised by age and sex to this population in 2011. We used Cox proportional hazards regression to estimate hazard ratios and a modified Cox regression, taking into account competing risks to derive sub-hazard ratios, for the association of ethnicity with all-cause and cause-specific mortality.

FINDINGS

We identified 18 201 individuals with a valid diagnosis of severe mental illness (median follow-up 6·36 years, IQR 3·26-9·92), of whom 1767 died. Compared with the general population, age-and-sex-standardised mortality ratios (SMRs) in people with severe mental illness were increased for a range of causes, including suicides (7·65, 95% CI 6·43-9·04), non-suicide unnatural causes (4·01, 3·34-4·78), respiratory disease (3·38, 3·04-3·74), cardiovascular disease (2·65, 2·45-2·86), and cancers (1·45, 1·32-1·60). SMRs were broadly similar in different ethnic groups with severe mental illness, although the south Asian group had a reduced SMR for cancer mortality (0·49, 0·21-0·96). Within the cohort with severe mental illness, hazard ratios for all-cause mortality and sub-hazard ratios for natural-cause and unnatural-cause mortality were lower in most ethnic minority groups relative to the white British group.

INTERPRETATION

People with severe mental illness have excess mortality relative to the general population irrespective of ethnicity. Among those with severe mental illness, some ethnic minorities have lower mortality than the white British group, for which the reasons deserve further investigation.

FUNDING

UK Health Foundation and UK Academy of Medical Sciences.

Determinants of cancer screening in Asian-Americans

PURPOSE

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.

METHODS

Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.

RESULTS

Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs.

CONCLUSIONS

AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.

Middle Eastern Conflicts: Implications for Refugee Health in the European Union and Middle Eastern Host Countries

Until very recently, health care in conflict settings was based on a model developed in the second half of the twentieth century. Things have changed, and present civil wars, such as those that are currently taking place in the Middle East, do not address the complexity of the ongoing armed conflicts in countries such as Syria, Iraq, and Afghanistan. These conflicts have caused a significant increase in the number of refugees in the region, as well as in Europe. Hundreds of thousands of refugees succeed in settling in mid- and north-European countries, and their health issues are becoming of great importance. Refugees in Europe in the twenty-first century do not suffer so much from infectious diseases but more from noninfectious chronic diseases such as diabetes, cardiac disease, and cancer. These facts profoundly alter the demographics and disease burden of hostility-derived migrants. Thus, host European countries face situations they have never faced before. Hence, new approaches and strategies are urgently needed to cope with this new situation. The efforts to absorb refugees of different traditions and cultural backgrounds often cause increasing ethnic and religious tensions, which frequently escort the emergence of social violence. To date, little attention has been paid to the overall load of distress being experienced, especially among the first-generation refugees. The current ongoing hostilities in the Middle East induce a long-term health impact on people expelled from their homes, communities, traditions, and cultural environment. The realization of collective suffering forces communities and governmental health agencies to develop new programs that include social determinants to overcome the severe cultural gaps of the newcomers in their new European host countries.

Cancer survival differences between South Asians and non-South Asians of England in 1986-2004, accounting for age at diagnosis and deprivation

BACKGROUND

South Asian migrants show lower cancer incidence than their host population in England for most major cancers. We seek to study the ethnic differences in survival from cancer.

METHODS

We described and modelled the effect of ethnicity, time, age and deprivation on survival for the five most incident cancers in each sex in South Asians in England between 1986 and 2004 using national cancer registry data. South Asian ethnicity was flagged using the validated name-recognition algorithm SANGRA (South Asian Names and Group Recognition Algorithm).

RESULTS

We observed survival advantage in South Asians in earlier periods. This ethnic gap either remained constant or narrowed over time. By 2004, age-standardised net survival was comparable for all cancers except three in men, where South Asians had higher survival 5 years after diagnosis: colorectal (58.9% vs 53.6%), liver (15.0% vs 9.4%) and lung (15.9% vs 9.3%). Compared with non-South Asians, South Asians experienced a slower increase in breast and prostate cancer survival, both cancers associated with either a screening programme or an early diagnosis test. We did not find differential patterns in survival by deprivation between both ethnicities.

CONCLUSIONS

Considering recent survival trends, appropriate action is required to avoid deficits in cancer survival among South Asians in the near future.

Incidence of gastrointestinal cancers by ethnic group in England, 2001-2007

OBJECTIVE

To compare the incidence of six gastrointestinal cancers (colorectal, oesophageal, gastric, liver, gallbladder and pancreatic) among the six main 'non-White' ethnic groups in England (Indian, Pakistani, Bangladeshi, Black African, Black Caribbean and Chinese) to each other and to Whites.

METHODS

We analysed all 378 511 gastrointestinal cancer registrations from 2001-2007 in England. Ethnicity was obtained by linkage to the Hospital Episodes Statistics database and we used mid-year population estimates from 2001-2007. Incidence rate ratios adjusted for age, sex and income were calculated, comparing the six ethnic groups (and combined 'South Asian' and 'Black' groups) to Whites and to each other.

RESULTS

There were significant differences in the incidence of all six cancers between the ethnic groups (all p<0.001). In general, the 'non-White' groups had a lower incidence of colorectal, oesophageal and pancreatic cancer compared to Whites and a higher incidence of liver and gallbladder cancer. Gastric cancer incidence was lower in South Asians but higher in Blacks and Chinese. There was strong evidence of differences in risk between Indians, Pakistanis and Bangladeshis for cancer of the oesophagus, stomach, liver and gallbladder (all p<0.001) and between Black Africans and Black Caribbeans for liver and gallbladder cancer (both p<0.001).

CONCLUSIONS

The risk of gastrointestinal cancers varies greatly by individual ethnic group, including within those groups that have traditionally been grouped together (South Asians and Blacks). Many of these differences are not readily explained by known risk factors and suggest that important, potentially modifiable causes of these cancers are still to be discovered.

Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers

PURPOSE

Human papillomavirus (HPV) has been identified as the cause of the increasing oropharyngeal cancer (OPC) incidence in some countries. To investigate whether this represents a global phenomenon, we evaluated incidence trends for OPCs and oral cavity cancers (OCCs) in 23 countries across four continents.

METHODS

We used data from the Cancer Incidence in Five Continents database Volumes VI to IX (years 1983 to 2002). Using age-period-cohort modeling, incidence trends for OPCs were compared with those of OCCs and lung cancers to delineate the potential role of HPV vis-à-vis smoking on incidence trends. Analyses were country specific and sex specific.

RESULTS

OPC incidence significantly increased during 1983 to 2002 predominantly in economically developed countries. Among men, OPC incidence significantly increased in the United States, Australia, Canada, Japan, and Slovakia, despite nonsignificant or significantly decreasing incidence of OCCs. In contrast, among women, in all countries with increasing OPC incidence (Denmark, Estonia, France, the Netherlands, Poland, Slovakia, Switzerland, and United Kingdom), there was a concomitant increase in incidence of OCCs. Although increasing OPC incidence among men was accompanied by decreasing lung cancer incidence, increasing incidence among women was generally accompanied by increasing lung cancer incidence. The magnitude of increase in OPC incidence among men was significantly higher at younger ages (< 60 years) than older ages in the United States, Australia, Canada, Slovakia, Denmark, and United Kingdom.

CONCLUSION

OPC incidence significantly increased during 1983 to 2002 predominantly in developed countries and at younger ages. These results underscore a potential role for HPV infection on increasing OPC incidence, particularly among men.

Screening of 185DelAG, 1014DelGT and 3889DelAG BRCA1 mutations in breast cancer patients from North-East India

Around 1.35 million people of worldwide suffer from breast cancer each year, whereas in India, 1 in every 17 women develops the disease. Mutations of the Breast Cancer 1 (BRCA1) gene account for the majority of breast/ ovarian cancer families. The purpose of study was to provide a prevalence of BRCA1 germline mutations in the North-East Indian population. In relation to the personal and family history with the breast cancer, we found mutations in 6.25% and 12.5% respectively. Three mutations, 185DelAG, 1014DelGT and 3889DelAG, were observed in our North-East Indian patients in exons 2 and 11, resulting in truncation of the BRCA1 protein by forming stop codons individually at amino acid positions 39, 303 and 1265. Our results point to a necessity for an extensive mutation screening study of high risk breast cancer cases in our North-East Indian population, which will provide better decisive medical and surgical preventive options.

Primary liver cancer incidence and survival in ethnic groups in England, 2001-2007

BACKGROUND

The patterns of primary liver cancer incidence and survival are not known for detailed ethnic groups within the UK.

METHODS

Data on patients resident in England diagnosed with primary liver cancer (ICD-10 C22) between 2001 and 2007 were extracted from the National Cancer Data Repository. Age-standardised incidence rate ratios (IRRs) were calculated for different ethnic groups separately for males and females, using the White ethnic groups as baselines. Overall survival was analysed using Cox regression, adjusting sequentially for age, socioeconomic deprivation and co-morbidity.

RESULTS

Ethnicity data were available for 75% (13,139/17,458) of primary liver cancer patients. Compared with the White male baseline, Chinese males had the highest IRR. Black African, Bangladeshi, Pakistani and Indian men also had statistically significant high IRRs. Black Caribbean men had a marginally elevated incidence rate compared with White men. In comparison with White women, Pakistani women had the highest IRR. Bangladeshi, Chinese, Black African and Indian women also had high IRRs. As observed in men, Black Caribbean women had an incidence rate closer to that of White women. Pakistani men and women, Black African women and Chinese men had statistically significantly better survival compared with their White counterparts.

CONCLUSION

The variation found in the incidence of primary liver cancer, could be due to established risk factors such as hepatitis B and C infection being more prevalent among certain ethnic groups. Country of birth, age at migration and length of stay in England are likely to be important factors in this disease, and future research should examine these where possible.

Cancer incidence in South Asian migrants to England, 1986-2004: unraveling ethnic from socioeconomic differentials

Studies on cancer in migrants are informative about the relative influence of environmental and genetic factors on cancer risk. This study investigates trends in incidence from colorectal, lung, breast and prostate cancer in England among South Asians and examines the influence of deprivation, a key environmental exposure. South Asian ethnicity was assigned to patients recorded in the population-based National Cancer Registry of England during 1986-2004, using the computerized algorithm SANGRA: South Asian Names and Groups Recognition Algorithm. Population denominators were derived from population censuses. Multivariable flexible (splines) Poisson models were used to estimate trends and socioeconomic differentials in incidence in South Asians compared to non-South Asians. Overall, age-adjusted cancer incidence in South Asians was half that in non-South Asians but rose over time. Cancer-specific incidence trends and patterns by age and deprivation differed widely between the two ethnic groups. In contrast to non-South Asians, lung cancer incidence in South Asians did not fall. Colorectal and breast cancer incidence rose in both groups, more steeply in South Asians though remaining less common than in non-South Asians. The deprivation gaps in cancer-specific incidence were much less marked among South Asians, explaining some of the ethnic differences in overall incidence. Although still lower than in non-South Asians, cancer incidence is rising in South Asians, supporting the concept of transition in cancer incidence among South Asians living in England. Although these trends vary by cancer, they have important implications for both prevention and anticipating health-care demand.

Inequalities in mortality among refugees and immigrants compared to native Danes--a historical prospective cohort study

BACKGROUND

Comparisons of mortality patterns between different migrant groups, and between migrants and natives, are relevant to understanding, and ultimately reducing, inequalities in health. To date, European studies on migrants' mortality patterns are scarce and are based solely on country of birth, rather than migrant status. However, mortality patterns may be affected by implications in relation to migrant status, such as health hazards related to life circumstances before and during migration, and factors related to ethnic origin. Consequently, we investigated differences in both all-cause and cause-specific mortality from cancer and cardiovascular disease among refugees and immigrants, compared with the mortality among native Danes.

METHODS

A register-based, historical prospective cohort design. All refugees (n = 29,139) and family-reunited immigrants (n = 27,134) who, between 1 January 1993 and 31 December 1999, were granted right of residence in Denmark were included and matched 1:4 on age and sex with native Danes. To identify deaths, civil registration numbers were cross-linked to the Register of Causes of Death (01.01.1994-31.12.2007) and the Danish Civil Registration System (01.01.1994-31.12.2008). Mortality rate ratios were estimated separately for men and women by migrant status and region of birth, adjusting for age and income and using a Cox regression model, after a median follow-up of 10-13 years after arrival.

RESULTS

Compared with native Danes, all-cause mortality was significantly lower among female (RR = 0.78; 95%CI: 0.71;0.85) and male (RR = 0.64; 95%CI: 0.59-0.69;) refugees. The rates were also significantly lower for immigrants: women (RR = 0.44; 95%CI: 0.38;0.51) and men (RR = 0.43; 95%CI: 0.37;0.51). Both migrant groups also had lower cause-specific mortality from cancer and cardiovascular diseases. For both all-cause and cause-specific mortality, immigrants generally had lower mortality than refugees, and differences were observed according to ethnic origin.

CONCLUSIONS

Mortality patterns were overall advantageous for refugees and immigrants compared with native Danes. Research should concentrate on disentangling the reasons behind migrants' health advantages, in order to enlighten future preventive public-health efforts, for the benefit of the entire population.

Major ethnic group differences in breast cancer screening uptake in Scotland are not extinguished by adjustment for indices of geographical residence, area deprivation, long-term illness and education

Background:

Breast cancer screening data generally show lower uptake in minority ethnic groups. We investigated whether such variations occur in Scotland.

Methods:

Using non-disclosive computerised linkage we combined Scottish breast screening and Census 2001 data. Non-attendance at first breast-screening invitation (2002–2008) was compared between 11 ethnic groups using age-adjusted risk ratios (RR) with 95% confidence intervals (CI), multiplied by 100, using Poisson regression.

Results:

Compared with the White Scottish (RR=100), non-attendance was similar for Other White British (99.5, 95% CI 96.1–103.2) and Chinese (112.8, 95% CI 96.3–132.2) and higher for Pakistani (181.7, 95% CI 164.9–200.2), African (162.2, 95% CI 130.8–201.1), Other South Asian (151.7, 95% CI 118.9–193.7) and Indian (141.7, 95% CI 121.1–165.7) groups. Adjustment for rural vs urban residence, long-term illness, area deprivation and education, associated with risk of non-attendance, increased the RR for non-attendance except for Pakistani women where it was modestly attenuated (RR=164.9, 149.4–182.1).

Conclusion:

Our data show important inequality in breast cancer screening uptake, not attenuated by potential confounding factors. Ethnic inequalities in breast screening attendance are of concern especially given evidence that the traditionally lower breast cancer rates in South Asian groups are converging towards the risks in the White UK population. Notwithstanding the forthcoming review of breast cancer screening, these data call for urgent action.

Does the 'Scottish effect' apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study

BACKGROUND AND OBJECTIVES

Although ethnic group variations in cancer exist, no multiethnic, population-based, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in all-cancer, and lung, colorectal, breast and prostate cancers. DESIGN, SETTING, POPULATION, MEASURES AND ANALYSIS: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups.

RESULTS

For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups.

CONCLUSIONS

The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of cost-effectiveness of screening, given comparatively low cancer rates.

Ethnic Groups as Migrant Groups: Improving Understanding of Links Between Ethnicity/Race and Risk of Type 2 Diabetes and Associated Conditions

Most members of minority ethnic/racial groups in affluent western societies are recent immigrants or immediate descendants thereof. The health implications of ethnic groups also being migrant groups are important but often not fully explored. Research demonstrating developmental influences on the risk of type 2 diabetes and associated conditions suggests that migrants will differ in disease risk compared with the general population. It also leads us to expect intergenerational differences in disease risk within many minority ethnic/racial groups. Differences in health behaviors between ethnic/racial groups are also expected to change over time following migration, including across generations, but do not necessarily follow a simple model of acculturation. Understanding the ways in which the biosocial heritage of migrant groups interacts over the long term with migrants' new environments is central to understanding differences in disease risk that are identified as ethnic or racial and also highlights heterogeneity in risk within ethnic groups.

Liver cancer epidemic in China: past, present and future

Primary liver cancer is the second most common malignancy, and currently results in 360,000 incident cases, and 350,000 deaths a year in China. For the past four decades, three national surveys on cancer mortality during the periods of 1973-1975, 1990-1992, and 2004-2005 have made it possible to estimate China's past and present liver cancer epidemic. The mortality rates of liver cancer were 17.6 and 7.3 per 100,000 for males and females in 1973-1975, 29.0 and 11.2 per 100,000 in 1990-1992, and 37.55 and 14.45 per 100,000 in 2004-2005, respectively. Recent monitoring from some regional cancer registries, which cover 5.7% of the total population in China, has revealed the distribution, disparities and trends of liver cancer in rural and urban areas. HBV and aflatoxins have been identified as major causal factors, that act individually and synergistically of liver cancer in the etiology. Other agents such as HCV, genetic susceptibility or genetic polymorphisms may also play important roles in the development of liver cancer. Great effort aimed at primary and Secondary prevention of this cancer, such as universal hepatitis B vaccination in children, chemoprevention in selected population, and early detection in at-risk population, has been undertaken. These strategies might be further emphasized in the future for the effective prevention of liver cancer in China.