在安大略癌症系统中，中国和南亚族群、移民身份与临床癌症结局。

Chinese and South Asian ethnicity, immigration status, and clinical cancer outcomes in the Ontario Cancer System.

机构信息

Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

出版信息

Cancer. 2018 Apr 1;124(7):1473-1482. doi: 10.1002/cncr.31231. Epub 2018 Jan 9.

DOI:10.1002/cncr.31231

PMID:29315535

Abstract

BACKGROUND

In the United States, certain minority groups have been shown to have inferior cancer outcomes compared with the white majority population. However, to the authors' knowledge, the majority of research has not separated ethnicity from immigration status. The objective of the current study was to determine the impact of ethnicity, independent of immigration status, on cancer outcomes in Chinese and South Asian populations in Ontario, Canada.

METHODS

The authors conducted a population-based retrospective cohort study using administrative databases in Ontario, Canada. Incident cancer cases were captured in Canadian-born Chinese and South Asian individuals, Chinese and South Asian immigrants, and the general Ontario reference population (non-Chinese/non-South Asian and non-immigrant) between 2000 and 2012. Subjects were followed until death (all-cause and cancer-specific), and Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on cancer outcomes after adjusting for explanatory variables.

RESULTS

A total of 423,678 cancer cases were identified; at total of 6631 cases were identified in Canadian-born Chinese individuals and 2752 cases in Canadian-born South Asian individuals. After adjustment, the rate of all-cause mortality was lower for Canadian-born Chinese (hazard ratio [HR], 0.829; 95% confidence interval [95% CI], 0.795-0.865), Canadian-born South Asian (HR, 0.856; 95% CI, 0.797-0.919), and Chinese immigrant (recent immigrant: HR, 0.661 [95% CI, 0.610-0.716] and non-recent immigrant: HR, 0.853 [95% CI, 0.803-0.906]) populations compared with the general Ontario population. A similar effect was found for cancer-specific mortality.

CONCLUSIONS

Chinese and South Asian ethnic groups appear to have lower cancer mortalities compared with the general Ontario population. After removing the well-documented protective effect of immigration, Chinese and South Asian ethnicities were found to be associated with a cancer survival advantage in Ontario, Canada. Cancer 2018;124:1473-82. © 2018 American Cancer Society.

摘要

背景

在美国，某些少数族裔的癌症预后明显不如白人多数族裔。然而，据作者所知，大多数研究并未将族裔与移民身份区分开来。本研究的目的是确定在加拿大安大略省，独立于移民身份的族裔对中国和南亚人群的癌症结局的影响。

方法

作者使用加拿大安大略省的行政数据库进行了一项基于人群的回顾性队列研究。2000 年至 2012 年间，在加拿大出生的中国人和南亚人、中国和南亚移民以及安大略省一般参考人群（非中国/非南亚和非移民）中捕获了癌症发病病例。对受试者进行随访直至死亡（全因和癌症特异性），并使用 Cox 比例风险模型来估计中国和南亚族裔在调整解释变量后对癌症结局的影响。

结果

共确定了 423678 例癌症病例；在加拿大出生的中国人中有 6631 例，加拿大出生的南亚人中有 2752 例。调整后，加拿大出生的中国人（危险比 [HR]，0.829；95%置信区间 [95%CI]，0.795-0.865）、加拿大出生的南亚人（HR，0.856；95%CI，0.797-0.919）和中国移民（新移民：HR，0.661[95%CI，0.610-0.716]和非新移民：HR，0.853[95%CI，0.803-0.906]）的全因死亡率均低于安大略省一般人群。癌症特异性死亡率也出现了类似的效果。