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Tsegaye AT, Lin J, Cole AM, Szpiro A, Rao DW, Walson J, Winer RL. Adherence and Correlates of Cervical Cancer Screening Among East African Immigrant Women in Washington State. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02038-5. [PMID: 38849693 DOI: 10.1007/s40615-024-02038-5] [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: 12/14/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Cervical cancer screening (CCS) among East African immigrants (EAI) in the USA is under explored. This study aimed to investigate adherence to CCS and its correlates among EAI. METHODS We identified 1664 EAI women (25-65 years) with ≥ 1 primary care clinic visit(s) between 2017 and 2018, using University of Washington (UW) Medicine electronic health record data. CCS adherence was defined as Pap testing within 3 years or human papillomavirus/Pap co-testing within 5 years. We used Poisson regression with robust standard errors to cross-sectionally estimate associations with correlates of adherence. Twelve-month screening uptake was also evaluated among overdue women. RESULTS CCS adherence was 63%. Factors associated with higher adherence included older age (adjusted prevalence ratios [APRs]:1.47:95%CI:1.14-1.90, 1.38:95%CI:1.05-1.80, respectively, for ages 30-39 and 40-49 vs 25-29 years), longer duration of care at UW Medicine (APR:1.22:95%CI:1.03-1.45, comparing > 10 vs < 5 years), higher visit frequency (APR:1.23:95%CI:1.04-1.44, 1.46:95%CI:1.24-1.72, respectively, for 3-5 and ≥ 6 vs 1-2 visits), index visit in an obstetrics-gynecology clinic (APR:1.26:95%CI:1.03-1.55, vs family practice), having an assigned primary care provider (APR:1.35: 95%CI:1.02-1.79), breast cancer screening adherence (APR:1.66: 95%CI:1.27-2.17), and colorectal cancer screening adherence (APR:1.59:95%CI:1.24-2.03). Low BMI was associated with lower adherence (APR:0.50:95%CI:0.26-0.96, comparing < 18.5 kg/m2 vs 18.5-24.9 kg/m2). Among 608 (37%) overdue women, 9% were screened in the subsequent 12 months. Having commercial health insurance vs Medicare/Medicaid was associated with higher uptake (adjusted risk ratio:2.44:95%CI:1.15-5.18). CONCLUSION CCS adherence among EAI was lower than the national average of 80%. Interventions focused on increasing healthcare access/utilization or leveraging healthcare encounters to address barriers could increase CCS in EAIs.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA.
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
| | - Allison M Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, USA
| | - Adam Szpiro
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA
| | - Darcy W Rao
- Gender Equality Division, Bill & Melinda Gates Foundation, Seattle, USA
| | - Judd Walson
- Departments of Global Health, Medicine (Infectious Diseases), Pediatrics and Epidemiology University of Washington, Seattle, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, 3980 15Th Ave NE UW Box # 351619, Seattle, WA, 98195, USA
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Lofters AK, Sammott SA, Swayze S, Bender JL, Alibhai SMH, Henry A, Noel K, Datta G. Stage of diagnosis and survival for prostate cancer among immigrant men in Ontario, Canada. Cancer Epidemiol 2024; 90:102562. [PMID: 38513543 DOI: 10.1016/j.canep.2024.102562] [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: 11/28/2023] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION We previously identified specific immigrant groups (West African and Caribbean) with increased incidence of prostate cancer in Ontario, Canada. In this population-level retrospective cohort study, we used administrative databases to compare stage of diagnosis, 5-year overall survival and prostate cancer-specific survival for immigrants versus long-term residents of Ontario. METHODS We linked several provincial-level databases available at ICES, an independent, non-profit research institute. We included all male Ontario residents 20-105 years of age who had an incident prostate cancer diagnosis date between March 31, 2008 and March 31, 2017, stratified into immigrants vs. long-term residents. We used multivariable logistic regression to determine the odds of early (stage I-II) vs. late (III-IV) stage of diagnosis, adjusting for age, co-morbidities, neighbourhood income and continuity of care. We produced Kaplan-Meier curves for 5-year overall survival and for 5-year prostate cancer-specific survival. RESULTS Compared to long-term residents, men from West Africa (adjusted odds ratio 1.66 [95% CI 1.16-2.38], East Africa (AOR 1.54 [95% CI 1.02-2.33]) and the Caribbean (AOR 1.22 [95% CI 1.01-1.47]) had a diagnostic stage advantage, and men from South Asia were most likely to be diagnosed at a late stage. In both unadjusted and adjusted analyses, overall and prostate cancer-specific survival were higher for immigrants than long-term residents. The highest five-year overall survival was seen for men from Sub-Saharan Africa and the Caribbean, and the lowest was seen for South Asian men, where 11.7% died within five years of diagnosis. CONCLUSION Immigrant men in Ontario with prostate cancer are more likely to be diagnosed at an early stage and to survive for 5 years than long-term residents. Among immigrant men, men from the Caribbean and Sub-Saharan Africa have the greatest stage and survival advantage and South Asian men the least. Differences in awareness, diagnostic suspicion, genetic predisposition, and social factors may play a role in these findings.
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Affiliation(s)
- Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Canada; Women's College Hospital Research Institute, Toronto, Canada; ICES, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Stacie-Ann Sammott
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | | | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Shabbir M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Medicine, University Health Network, Toronto, Canada
| | | | | | - Geetanjali Datta
- Cedars-Sinai Medical Center, Department of Biomedical Sciences, Los Angeles, USA
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Cha J, Bustamante G, Lê-Scherban F, Duprez D, Pankow JS, Osypuk TL. Ethnic Enclaves and Incidence of Cancer Among US Ethnic Minorities in the Multi-Ethnic Study of Atherosclerosis. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01814-z. [PMID: 37801279 PMCID: PMC11110072 DOI: 10.1007/s40615-023-01814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Since immigrants and their descendants represent a growing proportion of the US population, there is a strong demographic imperative for scientists to better understand the cancer risk factors at multiple levels that exist for these populations. Understanding the upstream causes of cancer, including neighborhood context, may help prevention efforts. Residence in ethnic enclaves may be one such contextual cause; however, the evidence is mixed, and past research has not utilized prospective designs examining cancer incidence or mortality. METHODS We examined the association between residency in ethnic enclaves and cancer events among Hispanic (n = 753) and Chinese (n = 451) participants without a history of cancer in the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study that enrolled participants ages 45-84 in six US cities. Cancer events included deaths and hospitalization for any cancer diagnosis from 2000-2012. Residency in an ethnic enclave was operationalized as their geocoded baseline census tract having a concentration of residents of the same ethnicity greater than the 75th percentile (compared to non-ethnic enclave otherwise). Potential confounders were blocked into three categories: sociodemographic, acculturation, and biomedical/health behavior variables. To examine the association between ethnic enclaves and cancer, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards models. RESULTS Among Hispanic participants, residing in ethnic enclaves (vs. not) was associated with a 39% reduction in cancer risk (HR 0.61, 95%CI: 0.31, 1.21) after adjusting for sociodemographic variables. Among Chinese participants, residing in ethnic enclaves was associated with a 2.8-fold increase in cancer risk (HR 2.86, 95%CI; 1.38, 5.94) after adjusting for sociodemographic variables. CONCLUSIONS Our results suggest that the association between ethnic enclaves and cancer events differs by ethnic group, suggesting that different social and contextual factors may operate in different communities.
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Affiliation(s)
- Jinhee Cha
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Gabriela Bustamante
- Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, MN, USA
- Instituto de Medicina Social & Desafíos Globales, School of Public Health, Universidad San Francisco de Quito, Quito, Ecuador
| | - Félice Lê-Scherban
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Daniel Duprez
- Cardiovascular Division, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Theresa L. Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
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Fang X, Davids J, Koestner R. Disparities in Healthcare Accessibility and Discrimination Faced by Black Quebecers: a Race and Language Perspective. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01724-0. [PMID: 37495906 DOI: 10.1007/s40615-023-01724-0] [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: 05/10/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023]
Abstract
The Black population in Canada is characterized by its long-established history and diversity. The present study aims to expand our current understanding of the relation between discrimination and disparities in healthcare by including race and language as determinants of health. We recruited 531 Black adults who are currently living in Quebec, Canada, to complete a survey measuring socio-demographic characteristics, mental and physical health, accessibility to healthcare, and experiences of discrimination. Results showed that being a racialized and linguistic minority population in Quebec, English-speaking Black participants experienced more discrimination, fewer healthcare providers, less access to COVID-19 information during the COVID-19 pandemic, and were more dissatisfied with the healthcare system than French-speaking Black participants. Furthermore, the negative impacts of healthcare access associated with being a racialized and linguistic minority population in Quebec (e.g., the English-speaking Black population) were shown to be mediated by experiences of discrimination and dissatisfaction with the healthcare system.
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Affiliation(s)
| | - John Davids
- Black Community Resource Centre, Montreal, Canada
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Sharp L, Dodlek N, Willis D, Leppänen A, Ullgren H. Cancer Prevention Literacy among Different Population Subgroups: Challenges and Enabling Factors for Adopting and Complying with Cancer Prevention Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105888. [PMID: 37239613 DOI: 10.3390/ijerph20105888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
It is estimated that 40% of the cancer cases in Europe could be prevented if people had better information and tools to make healthier choices and thereby reduce some of the most important cancer risk factors. The aim of this study is to gain knowledge and understanding about cancer prevention literacy among people with intellectual disabilities, immigrants, young people and young cancer survivors. In this qualitative study, we conducted six online focus-group interviews, including forty participants, to explore the cancer prevention literacy of four population subgroups and determine how cancer prevention recommendations according to the European Code Against Cancer (ECAC) were perceived. The analysis resulted in the following main categories: current health beliefs and their impacts on how the ECAC recommendations were perceived, communication strategies and sources benefiting or hindering cancer prevention information from reaching out, and how vulnerabilities in these subgroups impact cancer prevention literacy. To improve cancer prevention literacy in Europe, more attention is needed this topic to overcome barriers among different population subgroups. Recommendations include improved and adapted cancer prevention information, support to individuals, as well as societal support, such as easy-access screening and vaccination programmes and regulations related to tobacco, alcohol, and diet.
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Affiliation(s)
- Lena Sharp
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
| | - Nikolina Dodlek
- Department for Oncology, University Hospital Center Osijek, 31000 Osijek, Croatia
- Department of Nursing, Cyprus University of Technology, Limassol 3036, Cyprus
- Nursing and Palliative Care, Faculty for Medicine and Dental Health, 31000 Osijek, Croatia
| | - Diane Willis
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
| | - Arja Leppänen
- Regional Cancer Centre, Stockholm-Gotland, SE-10425 Stockholm, Sweden
| | - Helena Ullgren
- Department of Nursing, Umeå University, SE-90187 Umeå, Sweden
- ME Head & Neck, Lung & Skin Cancer, Karolinska Comprehensive Cancer Center, SE-17176 Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Dhaher NF, Pikkemaat M, Shaat N, Nilsson A, Bennet L. Cancer, cardiovascular disease, and all-cause mortality in Iraqi- and Swedish-born individuals in Sweden: the MEDIM cohort study. Sci Rep 2023; 13:6129. [PMID: 37061557 PMCID: PMC10105731 DOI: 10.1038/s41598-023-33379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/12/2023] [Indexed: 04/17/2023] Open
Abstract
Immigrants from the Middle East to Sweden have a twice as high prevalence of type 2 diabetes (T2D) and obesity as native-born Swedes. Both obesity and T2D have been linked to increased incidence of cancer, cardiovascular disease (CVD) and all-cause mortality (ACM); however, data on differences between ethnicities are scarce. In a population-based cohort we aimed to study the impact of Middle Eastern and European ethnicity on ACM, cancer- and CVD related mortality, incidence of cancer and CVD in an eight-year follow-up study. Methods: People born in Iraq or Sweden, who were 30-75 years of age, were invited from 2010 to 2012 to participate in the population based MEDIM study including a health exam, fasting blood sampling, assessment of insulin secretion and action (through oral glucose tolerance test) and questionnaires assessing history of CVD, cancer and T2D. Register data were retrieved from baseline until the 31st of December 2018 from the Swedish National Patient Register and Cause of Death register regarding CVD diagnosis, cancer diagnosis and cause of death. Information regarding diabetes diagnosis was retrieved from the National Diabetes Register. Individuals with a history of cancer or CVD at baseline were excluded. Cox regression analysis was assessed to study the adjusted hazard ratios (HR) for the relationships between ethnicity and ACM, cancer events, CVD events, death from cancer, and death from CVD, with adjustments for age, sex, anthropometrical measures, T2D and lifestyle. A total of 1398 Iraqi- and 757 Swedish-born residents participated in the study. ACM was considerably lower in Iraqi- compared to Swedish-born individuals HR 0.32 (95% CI 0.13-0.79) (p < 0.05). Furthermore, cancer related morbidity and mortality HR 0.39 (0.22-0.69) (p < 0.01) as well as CVD related morbidity and mortality HR 0.56 (0.33-0.95) (p < 0.05) were lower in the Iraqi-born group compared to the Swedish-born group for. The differences in mortality and cancer rates across ethnicities are not fully explained by anthropometric, environmental or metabolic measures but lie elsewhere. Further studies are needed to increase the understanding of contributing mechanisms.
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Affiliation(s)
- Nadine Fadhel Dhaher
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
- Department of Endocrinology, Skåne University Hospital, Jan Waldenströms gata 24, 205 02, Malmö, Sweden.
| | - Miriam Pikkemaat
- Department of Clinical Sciences Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Nael Shaat
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Endocrinology, Skåne University Hospital, Jan Waldenströms gata 24, 205 02, Malmö, Sweden
| | - Anton Nilsson
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Louise Bennet
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
- Clinical Research and Trial Centre, Lund University Hospital, Lund, Sweden
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Willén L, Berglund A, Bergström S, Isaksson J, Bergqvist M, Wagenius G, Lambe M. Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden). PLoS One 2022; 17:e0278706. [PMID: 36520832 PMCID: PMC9754210 DOI: 10.1371/journal.pone.0278706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES While studies have found lower cancer risks and better cancer survival in immigrant populations, it is debated whether cancer care is offered on equal terms to all residents regardless of background. Our aim was to study patterns of care and outcomes in immigrants in a country with a tax-financed universal health care system. MATERIAL AND METHODS We used a population-based database to compare clinical presentation, management and mortality between Swedish-born and immigrant patients with non-small cell lung cancer (NSCLC). Analyses were adjusted for potential confounders. RESULTS We identified 40,075 patients diagnosed with NSCLC of which 84% were born in Sweden, 7% in Nordic and 9% in Non-Nordic countries. Non-Nordic immigrants were to a higher extent male, smokers, younger at diagnosis, had a better performance status and a higher educational level. No differences were seen regarding comorbidity burden or stage at diagnosis. Non-Nordic immigrants more often underwent positron emission tomography (PET) (aHR 1.32; 95% CI 1.19-1.45) and were more often discussed in a multidisciplinary team setting (aHR 1.30; 95% CI 1.17-1.44). There were no differences in treatment modalities following adjustment for age, with the exception of concurrent chemoradiotherapy in stage IIIA disease which was more common in Non-Nordic immigrants (aOR 1.34; 95% CI 1.03-1.74). Both overall and cause specific survival in non-metastatic disease were higher among Non-Nordic immigrants. Overall mortality in stage I-II: HR 0.81; 95% CI 0.73-0.90 and stage IIIA: HR 0.75; 95% CI 0.65-0.86. Following full adjustments, cause-specific mortality in stage I-II was aHR 0.86, 95% CI 0.75-0.98. CONCLUSION Taken together, only minor differences in management and outcomes were observed between Swedish-born and immigrant patients. We conclude that lung cancer care is offered on equal terms. If anything, outcomes were better in Non-Nordic immigrants with early stage NSCLC.
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Affiliation(s)
- Linda Willén
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | | | - Stefan Bergström
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Department of Oncology, Gävle Hospital, Gävle, Sweden
| | - Johan Isaksson
- Center for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Pulmonary Medicine, Gävle Hospital, Gävle, Sweden
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Michael Bergqvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
- Section of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Gunnar Wagenius
- Division of Oncology, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Regional Cancer Center Central Sweden, Uppsala, Sweden
- * E-mail:
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Disparities in the survival of endometrial cancer patients in a public healthcare system: A population-based cohort study. Gynecol Oncol 2022; 167:532-539. [PMID: 36192238 DOI: 10.1016/j.ygyno.2022.09.015] [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: 07/30/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Social determinants of health (SDH) have been shown to correlate with adverse cancer outcomes. It is unclear if their impact goes beyond behavioral risk or healthcare access. We aimed to evaluate the association of SDH with endometrial cancer outcomes in a public healthcare system. METHODS A retrospective cohort study of endometrial cancer patients diagnosed between 2009 and 2017 in Ontario, Canada. Clinical and sociodemographic variables were extracted from administrative databases. Validated multifactorial marginalization scores for domains of material deprivation, residential instability and ethnic concentration were used. Associations between marginalization and survival were evaluated using log-rank testing and Cox proportional hazards regression. RESULTS 20228 women with endometrial cancer were identified. Fewer patients in marginalized communities presented with early disease (70% vs. 76%, p < 0.001) and received surgery (89% vs. 93%, p < 0.001). Overall survival was shorter among marginalized patients (p < 0.001). On multivariable analysis adjusted for patient and disease factors, overall marginalization (HR = 1.22, 95% CI 1.03-1.08), material deprivation (HR = 1.22, 95% CI 1.10-1.35) and residential instability (HR = 1.32, 95% CI 1.19-1.46) were associated with increased risk of death (p < 0.001). CONCLUSIONS Socioeconomic marginalization is associated with an increased risk of death in endometrial cancer patients. Targetable events in the cancer care pathway should be identified to improve health equity. FUNDING This study was supported by a grant (#RD-196) from the Hamilton Health Sciences Juravinski Hospital and Cancer Center Foundation.
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Lofters AK, Bender JL, Swayze S, Alibhai S, Henry A, Noel K, Datta GD. Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study. CMAJ Open 2022; 10:E956-E963. [PMID: 36319026 PMCID: PMC9633052 DOI: 10.9778/cmajo.20220069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Prostate cancer incidence has been associated with various sociodemographic factors, such as race, income and age, but the association with immigrant status in Canada is unclear. In this population-based study in Ontario, Canada, we compared age-standardized incidence rates for immigrant males from various regions of origin with the rates of long-term residents. METHODS In this retrospective cohort study, we linked several provincial-level databases available at ICES, an independent, non-profit research institute. We included all males aged 20 years and older in the province of Ontario eligible for health care for each fiscal year (Apr. 1 to Mar. 31) in 2008-2016. We determined age-standardized prostate cancer incidence rates, stratifying by immigrant status (a binary variable) and region of origin. We used a log-binomial model to estimate adjusted incidence rate ratios, with long-term residents (Canadian-born Ontarians as well as those who immigrated before 1985, when available data on immigration starts) as the reference group. We included age, neighbourhood income and time since landing in the models. Additional models limited to immigrant males in the cohort included immigration admission category (economic class, family class, refugee, other) and time since landing in Canada. RESULTS There were 74594 incident cases of prostate cancer in the study period, 6742 of which were among immigrant males. Males who had immigrated from West Africa and the Caribbean had significantly higher incidence of prostate cancer than other immigrants and long-term residents: adjusted rate ratios of 2.71 (95% confidence interval [CI] 2.41-3.05) and 1.91 (95% CI 1.78-2.04), respectively. Immigrants from other regions, including East Africa and Middle-Southern Africa, had lower or similar incidence rates to long-term residents. Males from South Asia had the lowest adjusted rate ratio (0.47, 95% CI 0.45-0.50). INTERPRETATION The age-standardized incidence rate of prostate cancer from 2008 to 2016 was consistently and significantly higher among immigrants from West African and Caribbean countries than among other immigrants and long-term residents of the province. Future research in Canada should focus on further understanding heterogeneity in prostate cancer risk and epidemiology, including stage of diagnosis and mortality, for immigrants.
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Affiliation(s)
- Aisha K Lofters
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
| | - Jacqueline L Bender
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
| | - Sarah Swayze
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
| | - Shabbir Alibhai
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
| | - Anthony Henry
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
| | - Kenneth Noel
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
| | - Geetanjali D Datta
- Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif
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Eger G, Reuven Y, Dreiher J, Shvartzman P, Weiser M, Aizenberg D, Weizman A, Lev-Ran S. Effects of country of origin and wave of immigration on prevalence of schizophrenia among first and second-generation immigrants: A 30-year retrospective study. Schizophr Res 2022; 243:247-253. [PMID: 32229262 DOI: 10.1016/j.schres.2020.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/18/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare the rates of schizophrenia among 1st and 2nd generation immigrants from two distinct backgrounds and across sequential periods of immigration. METHODS A 30-years retrospective cohort study (187,184 individuals) of 1st and 2nd generation East-African immigrants (EAIs) and former Soviet-Union immigrants (FSUIs) who migrated to Israel between 1980 and 2012. EAIs were further divided according to waves of immigration. Period prevalence was calculated between the years 2002-2012. Multivariate logistic regression models were used to examine the association between immigration-related factors and prevalence of schizophrenia (Native-Born Israelis serving as reference group). RESULTS The prevalence of schizophrenia in 1st generation EAIs and FSUIs was 1.8% and 1.2%, respectively, compared to 1.0% among NBIs (p<0.001). The prevalence of schizophrenia among 2nd generation EAIs and FSUIs was 1.3% and 0.8%, respectively, compared to 0.6% among NBIs (p<0.001). Adjusted odds ratios for developing schizophrenia compared to NBIs were 1.6 (95%CI:1.4-1.8) and 2.1 (95%CI:1.6-2.7), among 1st and 2nd generation EAIs and 1.1 (95%CI:0.9-1.2) and 1.3 (95%CI:1.0-1.8) among 1st and 2nd generation FSUIs respectively. Among EAIs, we observed the highest rate of schizophrenia in the pioneer wave of immigrants with gradual decline across subsequent waves: 2.4%, 1.9% and 1.0% for the 1st, 2nd and 3rd waves of immigration, respectively (p<0.001). CONCLUSIONS The increased risk for developing schizophrenia among 2nd generation immigrants and among pioneer groups of immigrants emphasizes the importance of persistent investment in acculturation. Further studies elucidating the impact of country of origin and ethnic density on the risk for developing schizophrenia are warranted.
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Affiliation(s)
- G Eger
- Geha Mental Health Center, Israel.
| | - Y Reuven
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - J Dreiher
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
| | - P Shvartzman
- Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel.
| | - M Weiser
- Psychiatry division, "Sheba" Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | | | | | - S Lev-Ran
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Lev-Hasharon Mental Health Center, Israel
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11
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Tripathi O, He Y, Han BY, Paragas DG, Sharp N, Dan S, Srinivasan M, Palaniappan LP, Thompson CA. Cancer Mortality in U.S.-Born versus Foreign-Born Asian American Groups (2008-2017). Cancer Epidemiol Biomarkers Prev 2022; 31:58-65. [PMID: 34697057 PMCID: PMC8767961 DOI: 10.1158/1055-9965.epi-21-0359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Asian Americans (AA) are the fastest growing ethnic group in the United States with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. U.S.-born). METHODS Ninety-eight thousand eight hundred and twenty-six AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from U.S. death certificates (2008-2017) were analyzed. Thirteen cancers that contribute significantly to Asian-American cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet-/obesity-related, and infection-related. Ten-year age-adjusted mortality rates [AAMR; 95% confidence interval (CI); per 100,00] and standardized mortality ratios (SMR; 95% CI) using foreign-born as the reference group were calculated. RESULTS Overall, foreign-born AAs had higher mortality rates than U.S.-born. Japanese U.S.-born males had the highest tobacco-related mortality rates [foreign-born AAMR: 43.02 (38.72, 47.31); U.S.-born AAMR: 55.38 (53.05, 57.72)]. Screen-detected death rates were higher for foreign-born than U.S.-born, except for among Japanese males [SMR 1.28 (1.21-1.35)]. Diet-/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than U.S.-born; the highest rates were foreign-born males-Korean [AAMR 41.54 (39.54, 43.53)] and Vietnamese [AAMR 41.39 (39.68, 43.09)]. CONCLUSIONS We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than U.S.-born AAs. IMPACT Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.
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Affiliation(s)
- Osika Tripathi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
- San Diego State University School of Public Health, San Diego, California
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Yuelin He
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Bridgette Y Han
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Darynn G Paragas
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- College of Architecture, Arts and Humanities, Clemson University, Clemson, South Carolina
- College of Behavioral, Social and Health Sciences, Clemson University, Clemson, South Carolina
| | - Nora Sharp
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Computational and Systems Biology, University of California, Los Angeles, Westwood, California
| | - Shozen Dan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
| | - Malathi Srinivasan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Latha P Palaniappan
- Center for Asian Health Research and Education, Stanford Medicine, Stanford University, Stanford, California
- Department of Medicine, Stanford Medicine, Stanford University, Stanford, California
| | - Caroline A Thompson
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California.
- San Diego State University School of Public Health, San Diego, California
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12
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Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study. Cancer Causes Control 2021; 33:213-222. [PMID: 34743253 PMCID: PMC8776671 DOI: 10.1007/s10552-021-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
Purpose Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01513-2.
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McRoy L, Epané J, Ramamonjiarivelo Z, Zengul F, Weech-Maldonado R, Rust G. Examining the relationship between self-reported lifetime cancer diagnosis and nativity: findings from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Cancer Causes Control 2021; 33:321-329. [PMID: 34708322 DOI: 10.1007/s10552-021-01514-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Cancer incidence in the USA remains higher among certain groups, regions, and communities, and there are variations based on nativity. Research has primarily focused on specific groups and types of cancer. This study expands on previous studies to explore the relationship between country of birth (nativity) and all cancer site incidences among USA and foreign-born residents using a nationally representative sample. METHODS This is a cross-sectional study of (unweighted n = 22,554; weighted n = 231,175,933) participants between the ages of 20 and 80 from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Using weighted logistic regressions, we analyzed the impact of nativity on self-reported cancer diagnosis controlling for routine care, smoking status, overweight, race/ethnicity, age, and gender. We ran a partial model, adjusting only for age as a covariate, a full model with all other covariates, and stratified by race/ethnicity. RESULTS In the partial and full models, our findings indicate that US-born individuals were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.34, 95% CI [1.93; 2.84], p < 0.01) and (OR 1. 39, 95% CI [1.05; 1.84], p < 0.05), respectively. This significance persisted only among non-Hispanic Blacks when stratified by race. Non-Hispanic Blacks who were US-born were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.30, 95% [CI 1.31; 4.02], p < 0.05). CONCLUSION A variety of factors may reflect lower self-reported cancer diagnosis in foreign-born individuals in the USA other than a healthy immigrant advantage. Future studies should consider the factors behind the differences in cancer diagnoses based on nativity status, particularly among non-Hispanic Blacks.
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Affiliation(s)
| | | | | | - Ferhat Zengul
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - George Rust
- Florida State University College of Medicine, Tallahassee, FL, USA
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Kendzerska T, Povitz M, Leung RS, Boulos MI, McIsaac DI, Murray BJ, Bryson GL, Talarico R, Hilton JF, Malhotra A, Gershon AS. Obstructive Sleep Apnea and Incident Cancer: A Large Retrospective Multicenter Clinical Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:295-304. [PMID: 33268490 DOI: 10.1158/1055-9965.epi-20-0975] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/01/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To examine the association between the severity of obstructive sleep apnea (OSA) and nocturnal hypoxemia with incident cancer. METHODS This was a multicenter retrospective clinical cohort study using linked clinical and provincial health administrative data on consecutive adults who underwent a diagnostic sleep study between 1994 and 2017 in four academic hospitals (Canada) who were free of cancer at baseline. Cancer status was derived from the Ontario Cancer Registry. Cox cause-specific regressions were utilized to address the objective and to calculate the 10-year absolute risk difference (ARD) in the marginal probability of incident cancer and the number needed to harm (NNH). RESULTS Of 33,997 individuals considered, 33,711 with no missing OSA severity were included: median age, 50 years; 58% male; and 23% with severe OSA (apnea-hypopnea index >30). Of the 18,458 individuals with information on sleep time spent with oxygen saturation (SaO2) <90%, 5% spent >30% of sleep with SaO2 <90% (severe nocturnal hypoxemia). Over a median of 7 years, 2,498 of 33,711 (7%) individuals developed cancer, with an incidence rate of 10.3 (10.0-10.8) per 1,000 person-years. Controlling for confounders, severe OSA was associated with a 15% increased hazard of developing cancer compared with no OSA (HR = 1.15, 1.02-1.30; ARD = 1.28%, 0.20-2.37; and NNH = 78). Severe hypoxemia was associated with about 30% increased hazard (HR = 1.32, 1.08-1.61; ARD = 2.38%, 0.47-4.31; and NNH = 42). CONCLUSIONS In a large cohort of individuals with suspected OSA free of cancer at baseline, the severity of OSA and nocturnal hypoxemia was independently associated with incident cancer. IMPACT These findings suggest the need for more targeted cancer risk awareness in individuals with OSA.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Richard S Leung
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark I Boulos
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Brian J Murray
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gregory L Bryson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Departments of Anesthesiology and Pain Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
| | - John F Hilton
- Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Atul Malhotra
- Department of Medicine, the University of California, San Diego, California
| | - Andrea S Gershon
- ICES (formerly the Institute for Clinical Evaluative Sciences), Ottawa, Toronto, Ontario, Canada
- Department of Medicine, the University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Healthy immigrant effect in non-European Union immigrants in Portugal: after a decade of (non-)integration! Public Health 2020; 186:95-100. [PMID: 32795770 DOI: 10.1016/j.puhe.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was to characterise the existence of the healthy immigrant effect (HIE; better health initially, worsening with an increase in the length of residence) in a big city from a Western European country, particularly in a non-European Union immigrant population. STUDY DESIGN This is a cross-sectional study. METHODS We used data from the National Health Survey 2014 to compare the health status of the immigrant and Portuguese populations with different lengths of residence. After descriptive statistics, binary logistic regressions models, with adjusted levels and 95% confidence intervals, were used. RESULTS Immigrants were healthier than the Portuguese population (<10 years: odds ratio [OR] = 0.07; 95% confidence interval [CI] = [0.01; 0.51]; ≥10 years: OR = 0.62; 95% CI = [0.19; 2.03]), but had an increased likelihood of suffering from chronic diseases and risk behaviours with the increase in their length of stay in Portugal. After living in Portugal for more than 10 years, the immigrants showed no statistical difference in the main health indicators. CONCLUSIONS There was a tendency for the health status of immigrants to deteriorate over 10 years of residence in Portugal. To better understand the reasons behind the HIE, specific and tailored studies must be developed.
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Social determinants of colorectal cancer risk, stage, and survival: a systematic review. Int J Colorectal Dis 2020; 35:985-995. [PMID: 32314192 DOI: 10.1007/s00384-020-03585-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several social determinants of health have been examined in relation to colorectal cancer incidence, stage at diagnosis, and survival including income, education, neighborhood disadvantage, immigration status, social support, and social network. Colorectal cancer incidence rates are positively associated with income and other measures of socioeconomic status. In contrast, low socioeconomic status tends to be associated with poorer survival. METHODS The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1970 through April 1, 2019 were identified using the following MeSH search terms and Boolean algebra commands: colorectal cancer AND (incidence OR stage OR mortality) AND (social determinants OR neighborhood disadvantage OR racial discrimination OR immigration OR social support). RESULTS This review indicates that poverty, lack of education, immigration status, lack of social support, and social isolation play important roles in colorectal cancer stage at diagnosis and survival. CONCLUSIONS To address social determinants of colorectal cancer, effective interventions are needed that account for the social contexts in which patients live.
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Oncogenic Potential of Bisphenol A and Common Environmental Contaminants in Human Mammary Epithelial Cells. Int J Mol Sci 2020; 21:ijms21103735. [PMID: 32466334 PMCID: PMC7279350 DOI: 10.3390/ijms21103735] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022] Open
Abstract
There is an ample epidemiological evidence to support the role of environmental contaminants such as bisphenol A (BPA) in breast cancer development but the molecular mechanisms of their action are still not fully understood. Therefore, we sought to analyze the effects of three common contaminants (BPA; 4-tert-octylphenol, OP; hexabromocyclododecane, HBCD) on mammary epithelial cell (HME1) and MCF7 breast cancer cell line. We also supplied some data on methoxychlor, MXC; 4-nonylphenol, NP; and 2-amino-1-methyl-6-phenylimidazo [4–b] pyridine, PhIP. We focused on testing the prolonged (two months) exposure to low nano-molar concentrations (0.0015–0.0048 nM) presumed to be oncogenic and found that they induced DNA damage (evidenced by upregulation of pH2A.X, pCHK1, pCHK2, p-P53) and disrupted the cell cycle. Some agents induced epigenetic (methylation) changes of tumor suppressor genes TIMP3, CHFR, ESR1, IGSF4, CDH13, and GSTP1. Obviously, the accumulation of these molecular alterations is an essential base for cancer development. Consistent with this, we observed that these agents increased cellular invasiveness through collagen. Cellular abilities to form colonies in soft agar were increased for MCF7. Toxic agents induced phosphorylation of protein kinase such as EGFR, CREB, STAT6, c-Jun, STAT3, HSP6, HSP27, AMPKα1, FAK, p53, GSK-3α/β, and P70S6 in HME1. Most of these proteins are involved in potential oncogenic pathways. Overall, these data clarify the molecular alterations that can be induced by some common environmental contaminants in mammary epithelial cells which could be a foundation to understand environmental carcinogenesis.
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Myerson R, Lu T, Yuan Y, Liu GGE. Cancer diagnosis and care among rural-to-urban migrants in China. BMJ Glob Health 2020; 4:e001923. [PMID: 31908866 PMCID: PMC6936538 DOI: 10.1136/bmjgh-2019-001923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Cancer is a leading cause of death in China. Rural-to-urban migrants are a group of over 260 million people in China sometimes termed the 'floating' population. This study assessed the prevalence of cancer diagnosis and access to needed healthcare by residence and migration status in China. Methods We used data from the China Health and Retirement Longitudinal Survey, a nationally representative population-based random sample of adults age 45 years and older and their spouses in China. We used multivariable logistic regressions to compare outcomes among rural-to-urban migrants, local urban residents and local rural residents after adjusting for province of residence, socioeconomic status and demographic characteristics. Results The sample included 7335 urban residents, 9286 rural residents and 3255 rural-to-urban migrants. Prevalence of cancer diagnosis was 9.9 per 1000 population among rural-to-urban migrants (95% CI 6.5 to 15.1 per 1000 population). Rural-to-urban migrants had higher tobacco use (OR=2.01; 95% CI 1.59 to 2.56, p<0.001), lower use of a health check-up (OR=0.57; 95% CI 0.48 to 0.67, p<0.001) and lower prevalence of diagnosed cancer (OR=0.41; 95% CI 0.18 to 0.95, p=0.037) than urban residents. Among participants with diagnosed cancer, residence and migration status were not predictive of foregoing needed healthcare, but were predictive of diagnosis with a screen-detectable tumour (ie, breast, colon, prostate or cervical cancer) (OR=0.17; 95% CI 0.05 to 0.63, p=0.007 for rural residents; OR=0.34; 95% CI 0.09 to 1.22, p=0.098 for rural-to-urban migrants, compared with urban residents). Conclusion Rapid and large migration is still a driving force transitioning China. Due to some remaining dual policy settings in favour of local residents, rural migrants tend to use lower primary care and preventive health check-ups in general, and diagnosis of screen-detectable tumours in particular, leading to potentially higher risk of missing early diagnosis of cancers. Closing gaps in diagnosis of screen-detectable tumours could increase treatment and improve cancer outcomes.
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Affiliation(s)
- Rebecca Myerson
- Population Health Sciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Tianyi Lu
- Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, California, USA
| | - Yong Yuan
- Global Health Economics and Outcomes Research, Bristol-Myers Squibb Co, New York City, New York, USA
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Coughlin SS. A review of social determinants of prostate cancer risk, stage, and survival. Prostate Int 2019; 8:49-54. [PMID: 32647640 PMCID: PMC7335972 DOI: 10.1016/j.prnil.2019.08.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/15/2019] [Indexed: 11/15/2022] Open
Abstract
Social determinants of health that have been examined in relation to prostate cancer incidence, stage at diagnosis, and survival include socioeconomic status (income, education), neighborhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighborhood access to health services. Socioeconomic factors influence risk of prostate cancer. Prostate cancer incidence rates tend to be positively associated with socioeconomic status. On the other hand, low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in prostate cancer survival by socioeconomic status, race, education, and census tract-level poverty. The results of this review indicate that social determinants such as poverty, lack of education, immigration status, lack of social support, and social isolation play an important role in prostate cancer stage at diagnosis and survival. To address these social determinants and eliminate cancer disparities, effective interventions that account for the social and environmental contexts in which patients with cancer live and are treated are needed.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA, USA
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Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat 2019; 177:537-548. [DOI: 10.1007/s10549-019-05340-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/27/2019] [Indexed: 02/08/2023]
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Addo IY, Brener L, Asante AD, de Wit J. Determinants of post-migration changes in dietary and physical activity behaviours and implications for health promotion: Evidence from Australian residents of sub-Saharan African ancestry. Health Promot J Austr 2019; 30 Suppl 1:62-71. [PMID: 30710450 DOI: 10.1002/hpja.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/20/2018] [Indexed: 01/17/2023] Open
Abstract
ISSUE ADDRESSED Several studies have attributed excess weight gain after immigration to changes in dietary and physical activity behaviours. However, recognising the main factors that influence post-migration changes in dietary and physical activity behaviours is less clear, particularly among Australian residents of sub-Saharan African (SSA) ancestry. Drawing on acculturation theory, this study examines main factors driving changes in dietary and physical activity behaviours among Australian residents who were born in SSA and provides insight into the extent to which the factors are related to immigration. METHODS A qualitative design based on a phenomenological approach was employed and a quota sampling technique was used to recruit 24 study participants for in-depth interviews. RESULTS The study found significant self-reported changes in dietary and physical activity behaviours after immigration that increase the risk of excess weight gain. The changes in dietary and physical activity behaviours were mainly driven by issues related to availability, accessibility and affordability of dietary and physical activity products. Time management and factors related to convenience also emerged as key determinants of change in dietary and physical activity behaviours. Apparently, some factors noted by participants shape dietary and physical activity behaviours irrespective of immigration, and these factors include: tastes and cravings for foods; friends and family influence on behaviour; and misconceptions about food and exercise. CONCLUSION Migration from SSA to Australia contributed to changes (mainly less healthy) in dietary and physical activity behaviours. To a large extent, post-migration changes in dietary and physical activity behaviours were driven by socio-economic and environmental factors. SO WHAT?: Health promotion programs that address the risky behaviours associated with excess weight gain among Australian residents of SSA ancestry should pay more attention to socio-economic and environmental factors.
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Affiliation(s)
- Isaac Yeboah Addo
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Loren Brener
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Augustine Danso Asante
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - John de Wit
- Faculty of Arts and Social Sciences, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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The Immigrant Mortality Advantage in Canada, 2001 and 2011. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2019. [DOI: 10.1007/s12134-019-00655-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Taha Z, Eltom SE. The Role of Diet and Lifestyle in Women with Breast Cancer: An Update Review of Related Research in the Middle East. Biores Open Access 2018; 7:73-80. [PMID: 29862141 PMCID: PMC5982158 DOI: 10.1089/biores.2018.0004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Breast cancer is the most common malignancy among Arab women in Eastern Mediterranean Region (EMR). The incidence of breast cancer has substantially increased in recent years among this women population, especially those younger than 50, and the incidence is expected to double by 2030. Considerable experimental evidence supports the potential role of dietary habits and lifestyle in cancer etiology and cancer prevention. In this review we examined the literature for evidence to link dietary choices and the rise in incidence and mortality of breast cancer among women in EMR. A literature search was conducted in PubMed and Ovid MEDLINE databases up to December 2017. The search terms used are breast cancer prevalence, breast cancer incidence worldwide, breast cancer and: nutrition, protein intake, vitamin D intake, fat intake, phytoestrogens, EMR, Arab, Middle East, Gulf countries, the UAE Arab women, breast cancer risk, diet, and chemoprevention. We found evidence to suggest that there is an alarming epidemic of obesity among women in most of the EMR countries, especially Gulf Cooperation Council (GCC) countries. The rise in the new breast cancer cases among women could be attributed to excess body weight. Their dietary pattern, which correlates with obesity, can be an important factor in the etiology of cancer. Although very few studies were found to support a direct causal relationship between obesity and breast cancer in the EMR, circumstantial evidence clearly points to the possible role of the epidemic, obesity, in this population and the startling rise in cases of breast cancer. Well-designed and systematic studies are urgently needed to confirm these associations and to elucidate potential mechanisms. More urgently, calls to action are needed in many sectors and at all levels of society, to establish intensive strategies for reducing obesity and promoting an overall healthy diet. Continued and expanded research on diet, lifestyle, and breast cancer risk is urgently needed to build the foundation for future progress in evidence-based public health efforts.
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Affiliation(s)
- Zainab Taha
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Sakina E Eltom
- Department of Biochemistry & Cancer Biology, Meharry Medical College, Nashville, Tennessee.,Center for Women's Health Research, Meharry Medical College, Nashville, Tennessee
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