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Dassen RRE, Pelders S, de Munck L, Jager A, Hooning MJ, van Dam JH, Heemskerk-Gerritsen BAM. The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women. Breast 2023; 69:290-298. [PMID: 36940631 PMCID: PMC10034141 DOI: 10.1016/j.breast.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. METHODS We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). RESULTS In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. CONCLUSION Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.
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Affiliation(s)
- R R E Dassen
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - S Pelders
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - L de Munck
- Netherlands Comprehensive Cancer Organization, Research and Development, Utrecht, Netherlands
| | - A Jager
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - M J Hooning
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - J H van Dam
- Erasmus MC Cancer Institute, Oncological Surgery, Rotterdam, Netherlands
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2
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Lofterød T, Frydenberg H, Veierød MB, Jenum AK, Reitan JB, Wist EA, Thune I. The influence of metabolic factors and ethnicity on breast cancer risk, treatment and survival: The Oslo ethnic breast cancer study. Acta Oncol 2022; 61:649-657. [PMID: 35348396 DOI: 10.1080/0284186x.2022.2053573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/10/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast cancer risk remains higher in high-income compared with low-income countries. However, it is unclear to what degree metabolic factors influence breast cancer development in women 30 years after immigration from low- to a high-incidence country. METHODS Using Cox regression models, we studied the association between pre-diagnostic metabolic factors and breast cancer development, and whether this association varied by ethnicity among 13,802 women participating in the population-based Oslo Ethnic Breast Cancer Study. Ethnic background was assessed and pre-diagnostic metabolic factors (body mass index, waist:hip ratio, serum lipids and blood pressure) were measured. A total of 557 women developed invasive breast cancer, and these women were followed for an additional 7.7 years. RESULTS Among women with an unfavorable metabolic profile, women from south Asia, compared with western European women, had a 2.3 times higher breast cancer risk (HR 2.30, 95% CI 1.18-4.49). Compared with the western European women, the ethnic minority women were more likely to present with triple-negative breast cancer (TNBC) (OR 2.11, 95% CI 0.97-4.61), and less likely to complete all courses of planned taxane treatment (OR 0.26, 95% CI 0.08-0.82). Among TNBC women, above-median triglycerides:HDL-cholesterol (>0.73) levels, compared with below-median triglycerides:HDL-cholesterol (≤0.73) levels, was associated with 2.9 times higher overall mortality (HR 2.88, 95% CI 1.02-8.11). CONCLUSIONS Our results support the importance of metabolic factors when balancing breast cancer prevention and disease management among all women, and in particular among non-western women migrating from a breast cancer low-incidence to a high-incidence country.
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Affiliation(s)
- Trygve Lofterød
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Hanne Frydenberg
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Marit B Veierød
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anne Karen Jenum
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jon B Reitan
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
| | - Erik A Wist
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inger Thune
- Department of Oncology, Oslo University Hospital, Ullevål, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Health Services, UiT The Arctic University of Norway, Oslo, Norway
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3
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Herbach EL, Weeks KS, O'Rorke M, Novak NL, Schweizer ML. Disparities in breast cancer stage at diagnosis between immigrant and native-born women: A meta-analysis. Ann Epidemiol 2020; 54:64-72.e7. [PMID: 32950654 DOI: 10.1016/j.annepidem.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/10/2020] [Accepted: 09/13/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To synthesize existing observational evidence to identify disparities in stage at breast cancer diagnosis between foreign- and native-born women. We hypothesized immigrant women would be less likely than natives to be diagnosed at a localized stage. METHODS Systematic searches for studies detailing stage at breast cancer diagnosis by birthplace in PubMed, Embase, and Web of Science yielded 11 relevant cohort studies from six countries. Odds ratios were pooled using random effects models. RESULTS Foreign-born women were 12% less likely to be diagnosed with breast cancer at a localized stage than natives (OR 0.88, 95% CI 0.82-0.95). A similar disadvantage was observed in immigrants from Asia, Eastern Europe, Latin America and the Caribbean, and developing or in transition nations; immigrants from developed countries experienced the least disparity. CONCLUSIONS This meta-analysis confirmed the presence of significant differences in breast cancer stage at diagnosis as per nativity. Across diverse immigrant groups and host countries, foreign-born women were significantly less likely to be diagnosed with localized breast cancer than native women; the magnitude of the disparity varied by region and economic condition of immigrants' birthplace.
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Affiliation(s)
- Emma L Herbach
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.
| | - Kristin S Weeks
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Michael O'Rorke
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City
| | - Nicole L Novak
- Department of Community and Behavioral Health, University of Iowa, Iowa City
| | - Marin L Schweizer
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City; Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA
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4
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Levesque JV, Gerges M, Wu VS, Girgis A. Chinese-Australian women with breast cancer call for culturally appropriate information and improved communication with health professionals. Cancer Rep (Hoboken) 2020; 3:e1218. [PMID: 32671993 DOI: 10.1002/cnr2.1218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND For culturally and linguistically diverse patients, breast cancer presents complex physical, psychosocial, and health care challenges, often exacerbated by a lack of culturally appropriate information and communication barriers with the treating team (even with the help of interpreters). AIM This qualitative study aims to broadly explore the experience of breast cancer and coping strategies utilized by Chinese-Australian women. METHODS AND RESULTS Twenty-four Chinese-Australian women with breast cancer participated in either a semi-structured interview or a focus group conducted in participants' preferred language, audio-recorded, transcribed, and subjected to thematic analysis. Two prominent themes emerged, related to information seeking, and communication with health care professionals. The theme of information needs and seeking highlighted unmet information needs and the multiple sources that are consulted for information. The second theme, communication with health care professionals, language barriers, and preferences, identified varying degrees of involvement in treatment decision-making, preference for information and interactions in Cantonese or Mandarin, and problems with interpreter services. CONCLUSION Chinese women with breast cancer face significant challenges in obtaining adequate information and can feel excluded from treatment decision-making. Women in this study expressed their eagerness for obtaining accurate information and engaging in open communication with their doctors. There is a need for culturally sensitive information resources and decision aids to enhance communication between Chinese migrant patients with cancer and health care professionals. Clinician participation in cultural awareness training is also recommended.
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Affiliation(s)
- Janelle V Levesque
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Verena S Wu
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Kaitelidou D, Galanis P, Economou C, Mladovsky P, Siskou O, Sourtzi P. Inequalities Between Migrants and Non-Migrants in Accessing and Using Health Services in Greece During an Era of Economic Hardship. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:444-457. [PMID: 32028832 DOI: 10.1177/0020731420902604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A cross-sectional study was conducted from April 2013 until March 2014 to explore the existence of inequalities in access to and utilization of health services by migrants compared to non-migrants in Greece and to test the influence of various factors on these disparities. Also, we investigated the influence of several socioeconomic and demographic characteristics. Study population included 1,152 migrants and 702 non-migrants. Migrants, participants suffering from a chronic disease, those without health insurance, and patients who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in getting their medication. Uninsured participants, females, those unemployed or without a permanent occupational status, and those who assessed their health status as not at all good/a little good/moderate were statistically more likely to report unmet needs in access to health services during the last year. Regarding the use of health services, those with health coverage, non-migrants, and females were statistically more likely to go for a blood test as a hospital outpatient. Greece, despite administrative delays and barriers, provided full coverage to the uninsured, asylum seekers, and migrants, even many groups of undocumented migrants.
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Affiliation(s)
- Daphne Kaitelidou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Galanis
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Economou
- Department of Sociology, Panteion University of Social and Political Sciences, Athens, Greece
| | - Philipa Mladovsky
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Olga Siskou
- Department of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayota Sourtzi
- Department of Nursing, Sector of Public Health, Occupational Health Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Thai AA, Tacey M, Byrne A, White S, Yoong J. Exploring disparities in receipt of adjuvant chemotherapy in culturally and linguistically diverse groups: an Australian centre's experience. Intern Med J 2018; 48:561-566. [PMID: 28762618 DOI: 10.1111/imj.13572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Globally, racial and ethnic disparities exist in treatments and outcomes for cancer patients. In Australia, there are few published data related to cancer patients from culturally and linguistically diverse (CALD) backgrounds. AIM To explore disparities in adjuvant chemotherapy utilisation in cancer patients from CALD groups. METHODS Retrospective analysis of patients who were recommended adjuvant chemotherapy for early stage breast cancer or early stage colorectal cancer between July 2011 and October 2014 was performed. Rates of adjuvant chemotherapy uptake were analysed between those who identified English as their first-preferred language, versus those who did not, as well as between patients who were born in a country where English is the main language (non-CALD), versus those born in a country where English is not the main language (CALD). RESULTS Two hundred and eleven patients were identified. One hundred and forty-three (67.7%) patients had early stage breast cancer and 68 (32.2%) patients had early stage colorectal cancer. No difference was detected in the acceptance of adjuvant chemotherapy between non-CALD (80.9%) and CALD patients (81.3%, P = 0.984) or between patients who identified English as their first-preferred language (80.8%) and those who did not (81.8%, P = 0.870). There was no difference in the rate of chemotherapy completion, with 75.6% completion in the non-English-speaking group and 81.1% in the English-speaking group (P = 0.426). CONCLUSION No difference was observed in adjuvant chemotherapy utilisation in patients who identified English as their first-preferred language compared to those who did not, as well as between non-CALD and CALD groups. This is the first study to assess these differences in Australia.
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Affiliation(s)
- Alesha A Thai
- Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia
| | - Mark Tacey
- Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia.,Melbourne Epicentre and Northern Centre for Health Education and Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Byrne
- North Eastern Melbourne Integrated Cancer Service, Melbourne, Victoria, Australia
| | - Shane White
- Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia
| | - Jaclyn Yoong
- Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia.,Department of Supportive and Palliative Care, Monash Health, Melbourne, Victoria, Australia
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7
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Thøgersen H, Møller B, Robsahm TE, Aaserud S, Babigumira R, Larsen IK. Comparison of cancer stage distribution in the immigrant and host populations of Norway, 1990-2014. Int J Cancer 2017; 141:52-61. [DOI: 10.1002/ijc.30713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Håvard Thøgersen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
- University of Oslo, Faculty of Medicine, Institute of Basic Medical Sciences; Norway
| | - Bjørn Møller
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Trude Eid Robsahm
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Stein Aaserud
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Ronnie Babigumira
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
| | - Inger Kristin Larsen
- Cancer Registry of Norway, Institute of Population-Based Cancer Research; Norway
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8
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Abdoli G, Bottai M, Sandelin K, Moradi T. Breast cancer diagnosis and mortality by tumor stage and migration background in a nationwide cohort study in Sweden. Breast 2017; 31:57-65. [DOI: 10.1016/j.breast.2016.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/23/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022] Open
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9
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Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective. J Immigr Minor Health 2016; 19:448-476. [DOI: 10.1007/s10903-016-0347-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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10
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Goldstein D, Bell ML, Butow P, Sze M, Vaccaro L, Dong S, Liauw W, Hui R, Tattersall M, Ng W, Asghari R, Steer C, Vardy J, Parente P, Harris M, Karanth NV, King M, Girgis A, Eisenbruch M, Jefford M. Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors. Ann Oncol 2014; 25:1643-9. [PMID: 24827124 DOI: 10.1093/annonc/mdu182] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. PATIENTS AND METHODS This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. RESULTS Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. CONCLUSIONS This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
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Affiliation(s)
- D Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney
| | - M L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - M Sze
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - L Vaccaro
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - S Dong
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - W Liauw
- Cancer Care Centre, St George Hospital, Sydney
| | - R Hui
- Department of Medical Oncology, Westmead Hospital and Blacktown Oncology Unit, Blacktown Hospital Sydney, Sydney
| | - M Tattersall
- Department of Cancer Medicine, University of Sydney, Sydney Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney
| | - W Ng
- Department of Medical Oncology, Liverpool Hospital, Sydney
| | - R Asghari
- Bankstown Cancer Care Centre, Bankstown Lidcombe Hospital, Sydney
| | - C Steer
- Border Medical Oncology, Wodonga
| | - J Vardy
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - P Parente
- Department of Clinical Haematology and Medical Oncology, Box Hill Hospital, Victoria
| | - M Harris
- Department of Medical Oncology, Monash Medical Centre, Victoria
| | - N V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Northern Territory
| | - M King
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - A Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, and University of NSW, Sydney
| | - M Eisenbruch
- School of Psych, Psychiatry and Psych Medicine, Monash University, Victoria
| | - M Jefford
- Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria Division of Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Norredam M, Olsbjerg M, Petersen JH, Bygbjerg I, Krasnik A. Mortality from infectious diseases among refugees and immigrants compared to native Danes: a historical prospective cohort study. Trop Med Int Health 2011; 17:223-30. [DOI: 10.1111/j.1365-3156.2011.02901.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Norredam M, Kastrup M, Helweg-Larsen K. Register-based studies on migration, ethnicity, and health. Scand J Public Health 2011; 39:201-5. [DOI: 10.1177/1403494810396561] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Researchers in Denmark have unique possibilities of register-based research in relation to migration, ethnicity, and health. This review article outlines how these opportunities have been used, so far, by presenting a series of examples. Research topics: We selected six registers to highlight the process of how migrant study populations have been established and studied in relation to different registers: The Danish Cancer Registry, the Danish Central Psychiatric Research Register, the Danish National Patient Register, the Danish National Health Service Register, the Danish Injury Register, and the Danish Medical Birth Register. Conclusion: Our paper documents the unique opportunities to study migration, ethnicity, and health through Danish national registers. Our examples show that in Denmark ‘‘country of birth’’ is the most commonly used measure. It renders information on whether the person is an immigrant or not, and on ethnic background. Data on migration background (i.e. refugee status vs. family reunification, etc.) is more difficult to obtain and therefore less used. It has been debated if ethnicity should be registered upon using health services; however, some consider it discriminatory. Although, we do not register ethnicity in relation to use of health care in Denmark, our possibilities of linkage between population registers and registers on diseases and healthcare utilisation appear to render the same potentials.
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Affiliation(s)
- Marie Norredam
- Danish Research Centre for Migration, Ethnicity and
Health, Department of Public Health, University of Copenhagen, Copenhagen,
Denmark,
| | - Marianne Kastrup
- Centre for Transcultural Psychiatry, Psychiatric Centre
Copenhagen, Copenhagen, Denmark
| | - Karin Helweg-Larsen
- National Institute of Public Health, University of Southern
Denmark, Copenhagen, Denmark
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13
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Arnold M, Razum O, Coebergh JW. Cancer risk diversity in non-western migrants to Europe: An overview of the literature. Eur J Cancer 2011; 46:2647-59. [PMID: 20843493 DOI: 10.1016/j.ejca.2010.07.050] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 05/11/2010] [Accepted: 07/29/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cancer risk varies geographically and across ethnic groups that can be monitored in cancer control to respond to observed trends as well as ensure appropriate health care. The study of cancer risk in immigrant populations has great potential to contribute new insights into aetiology, diagnosis and treatment of cancer. Disparities in cancer risk patterns between immigrant and autochthonous populations have been reported many times, but up to now studies have been heterogeneous and may be discordant in their findings. The aim of this overview was to compile and compare studies on cancer occurrence in migrant populations from non-western countries residing in Western Europe in order to reflect current knowledge in this field and to appeal for further research and culturally sensitive prevention strategies. METHODS We included 37 studies published in the English language between 1990 and April 2010 focussing on cancer in adult migrants from non-western countries, living in the industrialised countries of the European Union. Migrants were defined based on their country of birth, ethnicity and name-based approaches. We conducted a between-country comparison of age-adjusted cancer incidence and mortality in immigrant populations with those in autochthonous populations. FINDINGS Across the board migrants from non-western countries showed a more favourable all-cancer morbidity and mortality compared with native populations of European host countries, but with considerable site-specific risk diversity: Migrants from non-western countries were more prone to cancers that are related to infections experienced in early life, such as liver, cervical and stomach cancer. In contrast, migrants of non-western origin were less likely to suffer from cancers related to a western lifestyle, e.g. colorectal, breast and prostate cancer. DISCUSSION Confirming the great cancer risk diversity in non-western migrants in and between different European countries, this overview reaffirms the importance of exposures experienced during life course (before, during and after migration) for carcinogenesis. Culturally sensitive cancer prevention programmes should focus on individual risk patterns and specific health care needs. Therefore, continuously changing environments and subsequently changing risks in both migrant and autochthonous populations need to be observed carefully in the future.
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Affiliation(s)
- Melina Arnold
- Department of Epidemiology and International Public Health, Bielefeld University, Germany.
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14
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Kristiansen M, Hassani A, Krasnik A. A qualitative assessment of implementing a cross-cultural survey on cancer wards in Denmark--a description of barriers. BMC Med Res Methodol 2010; 10:4. [PMID: 20067615 PMCID: PMC2820029 DOI: 10.1186/1471-2288-10-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 01/12/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research into migration and health is often confronted with methodological challenges related to the identification of migrants in various settings. Furthermore, it is often difficult to reach an acceptable level of participation among migrant groups in quantitative research. The aim of this study is to conduct a qualitative assessment of the barriers encountered during the implementation of a cross-cultural survey on cancer wards in Copenhagen, Denmark. METHODS Participant observation at the involved wards was combined with qualitative interviews with selected nurses and informal talks with a wider group of nurses at the wards involved in the survey. RESULTS One possible way to increase the participation of migrant patients in research is through the involvement of the hospital staff in contact with patients. Involvement of nurses on cancer wards in the delivery of questionnaires to patients was challenging, despite a general willingness to participate in psychosocial research. The main difficulties were found to be both external (policy changes, general strike among nurses) and internal on the wards (heavy workload, lack of time, focus on medical aspects of cancer rather than psychosocial aspects). These factors interacted and resulted in a lower priority being given to psychosocial research. Further, nurses expressed a feeling that researchers in general did not recognize their contribution in research, making it more difficult to engage fully in studies. CONCLUSIONS Involving hospital staff in research is feasible but not straightforward. Awareness of the influence of possible external and internal factors and efforts to deal with these factors are fundamental to the successful implementation of psychosocial cancer research in a hospital setting.
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Affiliation(s)
- Maria Kristiansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Nielsen SS, Krasnik A, Rosano A. Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content. BMC Health Serv Res 2009; 9:210. [PMID: 19922657 PMCID: PMC2788548 DOI: 10.1186/1472-6963-9-210] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 11/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cross-national comparable data on migrants' use of healthcare services are important to address problems in access to healthcare; to identify high risk groups for prevention efforts; and to evaluate healthcare systems comparatively. Some of the main obstacles limiting analyses of health care utilization are lack of sufficient coverage and availability of reliable and valid healthcare data which includes information allowing for identification of migrants. The objective of this paper was to reveal which registry data on healthcare utilization were available in the EU countries in which migrants can be identified; and to determine to what extent data were comparable between the EU countries. METHODS A questionnaire survey on availability of healthcare utilization registries in which migrants can be identified was carried out among all national statistic agencies and other relevant national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO). The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public Health, Lazio Region, Italy within the MEHO-project; thus, the information on registries was double-checked to assure accuracy and verification. RESULTS Available registry data on healthcare utilization which allow for identification on migrants on a national/regional basis were only reported in 11 EU countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants, five countries reported having information on both citizenship and country of birth, one reported availability of information on country of birth, and five countries reported availability of information on citizenship. CONCLUSION Lack of registry data in 16 EU countries, shortage of data on healthcare utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across the EU.
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Affiliation(s)
- Signe Smith Nielsen
- University of Copenhagen, Department of Public Health, Section for Health Services Research, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark.
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Précarité sociale, cancer et vulnérabilité psychique, lien direct ou indirect ? PSYCHO-ONCOLOGIE 2008. [DOI: 10.1007/s11839-008-0098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barraclough H, Morrell S, Arcorace M, McElroy HJ, Baker DF. Degree-of-spread artefact in the New South Wales Central Cancer Registry. Aust N Z J Public Health 2008; 32:414-6. [DOI: 10.1111/j.1753-6405.2008.00271.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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