Respiratory Epidemiology and Clinical Research Unit (Chen, MacIsaac, Ahodakin, Jeagal, Ezer, Gonzalez, Benedetti, Ahmad Khan), Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, and Montreal Chest Institute; Division of Respiratory Medicine (MacIsaac, Ezer, Gonzalez, Ahmad Khan) and Department of Oncology (Young, Agulnik, Owen, Pepe), Faculty of Medicine, McGill University; Cancer Registry (Boucher), McGill University Health Centre; Division of Pulmonary Diseases (Agulnik, Pepe), Jewish General Hospital, Montréal, Que.; Nunavik Regional Board of Health and Social Services (Boulanger, White-Dupuis, Grey), Kuujjuaq, Que.; Department of Pathology (Camilleri-Broët), Optilab, McGill University Health Centre; McGill University Health Centre (Owen); Department of Surgery (Spicer), McGill University; Division of Thoracic Surgery (Spicer), McGill University Health Centre; Jewish General Hospital (Wang); Department of Pathology (Wang), McGill University, Montréal, Que.; Ungava Tulattavik Health Centre (Watt), Kuujjuaq, Que.; Department of Epidemiology, Biostatistics and Occupational Health (Benedetti), McGill University, Montréal, Que.
CMAJ. 2024 Feb 19;196(6):E177-E186. doi: 10.1503/cmaj.230682.
Whether Inuit in Canada experience disparities in lung cancer survival remains unknown. When requiring investigation and treatment for lung cancer, all residents of Nunavik, the Inuit homeland in Quebec, are sent to the McGill University Health Centre (MUHC), in Montréal. We sought to compare survival among patients with lung cancer at the MUHC, who were residents of Nunavik and Montréal, Quebec, respectively.
We conducted a retrospective cohort study. Using lung cancer registry data, we identified Nunavik residents with histologically confirmed lung cancer diagnosed between 2005 and 2017. We aimed to match 2 Montréal residents to each Nunavik resident on sex, age, calendar year of diagnosis, and histology (non-small cell lung cancer v. small cell lung cancer). We reviewed medical records for data on additional patient characteristics and treatment, and obtained vital status from a provincial registry. We compared survival using Kaplan-Meier analysis and Cox proportional hazards regression.
We included 95 residents of Nunavik and 185 residents of Montréal. For non-small cell lung cancer, median survival times were 321 (95% confidence interval [CI] 184-626) days for Nunavik ( = 71) and 720 (95% CI 536-1208) days for Montréal residents ( = 141). For small cell lung cancer, median survival times were 190 (95% CI 159-308) days for Nunavik ( = 24) and 270 (95% CI 194-766) days for Montréal residents ( = 44). Adjusting for matching variables, stage, performance status, and comorbidity, Nunavik residents had a higher hazard of death (hazard ratio 1.68, 95% CI 1.17-2.41).
Nunavik residents experience disparities in survival after lung cancer diagnosis. Although studies in other Inuit Nunangat regions are needed, our findings point to an urgent need to ensure that interventions aimed at improving lung cancer survival, including lung cancer screening, are accessible to Inuit Nunangat residents.
加拿大因纽特人是否在肺癌存活率方面存在差异尚不清楚。努纳武特是魁北克的因纽特人聚居地，当这里的居民需要接受肺癌检查和治疗时，他们都会被送到位于蒙特利尔的麦吉尔大学健康中心（MUHC）。我们试图比较分别居住在努纳武特和魁北克省蒙特利尔的 MUHC 肺癌患者的存活率。
我们进行了一项回顾性队列研究。利用肺癌登记数据，我们确定了 2005 年至 2017 年间在 MUHC 确诊患有组织学证实的肺癌的努纳武特居民。我们旨在为每位努纳武特居民匹配 2 名来自蒙特利尔的居民，匹配因素包括性别、年龄、诊断年份和组织学（非小细胞肺癌与小细胞肺癌）。我们查阅病历以获取患者特征和治疗相关数据，并从省级登记处获取生存状态。我们使用 Kaplan-Meier 分析和 Cox 比例风险回归来比较生存率。
我们纳入了 95 名努纳武特居民和 185 名来自蒙特利尔的居民。对于非小细胞肺癌，努纳武特居民的中位生存时间为 321 天（95%置信区间 [CI] 184-626），而蒙特利尔居民为 720 天（95%CI 536-1208）（ = 71）。对于小细胞肺癌，努纳武特居民的中位生存时间为 190 天（95%CI 159-308），而蒙特利尔居民为 270 天（95%CI 194-766）（ = 24）。调整匹配变量、分期、表现状态和合并症后，努纳武特居民的死亡风险更高（风险比 1.68，95%CI 1.17-2.41）。
努纳武特居民在肺癌诊断后的生存状况存在差异。尽管需要在其他因纽特人努纳武特地区开展研究，但我们的研究结果表明，迫切需要确保旨在提高肺癌生存率的干预措施（包括肺癌筛查）能够惠及因纽特人努纳武特地区的居民。
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