Department of Haematology, Clinical Cancer Research Unit, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Eur J Epidemiol. 2024 Aug;39(8):881-892. doi: 10.1007/s10654-024-01139-z. Epub 2024 Jul 4.
Overall survival (OS) for patients with a hematological cancer may differ between immigrant and Danish-born patients due to disparities in socioeconomic status, health literacy, and language proficiency. This cohort study aimed to investigate survival and hospitalization according to immigrant status while controlling for confounders. Patients with newly diagnosed hematological cancer in 2000-2020 were identified in the Danish nationwide hematological registers and stratified into Danish-born, Western, and non-Western patients. Patients were followed from diagnosis until death, 31st December 2021, or emigration, whichever came first. Crude OS, standardized OS, and 5-years OS differences were computed using flexible parametric models and hazard ratios using Cox regression. Number of hospitalization days in the year before and after diagnosis, respectively, were calculated using Poisson regression. A total of 2,241 immigrants and 41,519 Danish-born patients with a hematological cancer were included. Standardized 5-years OS was similar between groups with 58% (95% confidence interval 57-58%) for Danish-born patients, 57% (55-60%) for Western, and 56% (53-58%) for non-Western immigrant patients. Subgroup analyses identified OS differences in selected subgroups. Non-Western immigrant patients had 1.3 (0.5-2.1) more hospitalization days in the year before diagnosis and an adjusted incidence rate ratio of hospitalization days of 1.14 (1.13-1.15) in the year after diagnosis compared with Danish-born patients. In conclusion, there were no overall differences in survival when comparing immigrant patients to Danish-born patients after controlling for relevant confounders. Healthcare utilization was slightly higher among non-Western immigrant patients before and after diagnosis, but differences were small on an individual patient level.
总体生存(OS)可能因社会经济地位、健康素养和语言能力等差异而在移民和丹麦出生的血液病患者之间存在差异。本队列研究旨在控制混杂因素后,调查不同移民状态下的生存和住院情况。2000-2020 年在丹麦全国血液病登记处确定了新诊断为血液病的患者,并将其分为丹麦出生、西方和非西方患者。患者从诊断开始随访,直至死亡、2021 年 12 月 31 日或移民,以先发生者为准。使用灵活参数模型计算粗 OS、标准化 OS 和 5 年 OS 差异,并使用 Cox 回归计算危险比。使用泊松回归分别计算诊断前和诊断后一年的住院天数。共纳入 2241 名移民和 41519 名丹麦出生的血液病患者。两组的标准化 5 年 OS 相似,丹麦出生患者为 58%(95%置信区间 57-58%),西方患者为 57%(55-60%),非西方移民患者为 56%(53-58%)。亚组分析确定了某些亚组的 OS 差异。与丹麦出生患者相比,非西方移民患者在诊断前一年的住院天数多 1.3(0.5-2.1)天,调整后的住院天数发病率比为 1.14(1.13-1.15)。总之,在控制相关混杂因素后,与丹麦出生患者相比,移民患者的总体生存率没有差异。非西方移民患者在诊断前后的医疗保健利用率略高,但在个体患者层面上差异较小。