Interdisciplinary Health Program, St. Francis Xavier University, Antigonish, NS, Canada.
Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada.
BMC Cancer. 2024 Sep 7;24(1):1114. doi: 10.1186/s12885-024-12804-7.
Lung cancer is one of the most common cancers and causes of cancer death in Canada. Some previous literature suggests that socioeconomic inequalities in lung cancer screening, treatment and survival may exist. The objective of this study was to compare overall survival for immigrants versus long-term residents of Ontario, Canada among patients diagnosed with lung cancer.
This population-based retrospective cohort study utilized linked health administrative databases and identified all individuals (immigrants and long-term residents) aged 40 + years diagnosed with incident lung cancer between April 1, 2012 and March 31, 2017. The primary outcome was 5-year overall survival with December 31, 2019 as the end of the follow-up period. We implemented adjusted Cox proportional hazards models stratified by age at diagnosis, sex, and cancer stage at diagnosis to examine survival.
Thirty-eight thousand seven hundred eighty-eight individuals diagnosed with lung cancer were included in our cohort including 7% who were immigrants. Immigrants were younger at diagnosis and were more likely to reside in the lowest neighbourhood income quintile (30.6% versus 24.5%) than long-term residents. After adjusting for age at diagnosis, neighbourhood income quintile, comorbidities, visits to primary care in the 6 to 30 months before diagnosis, continuity of care, cancer type and cancer stage at diagnosis, immigrant status was associated with a lower hazard of dying 5-years post-diagnosis for both females (0.7; 95% CI 0.6-0.8) and males (0.7; 95% CI 0.6-0.7) in comparison to long-term residents. This trend held in adjusted models stratified by cancer stage at diagnosis. For example, female immigrants diagnosed with early stage lung cancer had a hazard ratio of 0.5 (95% CI 0.4-0.7) in comparison to long-term residents.
Overall survival post diagnosis with lung cancer was better among Ontario immigrants versus long-term residents. Additional research, potentially on the protective effects of immigrant enclave and the intersection of immigrant status with racial/ethnic identity, is needed to further explore why better overall survival for immigrants remained.
肺癌是加拿大最常见的癌症和癌症死亡原因之一。一些先前的文献表明，肺癌筛查、治疗和生存方面可能存在社会经济不平等现象。本研究的目的是比较在加拿大安大略省被诊断患有肺癌的移民与长期居民的总生存率。
这是一项基于人群的回顾性队列研究，利用了关联的健康管理数据库，确定了所有（移民和长期居民）年龄在 40 岁以上、2012 年 4 月 1 日至 2017 年 3 月 31 日期间被诊断为肺癌的患者。主要结果是 5 年总生存率，以 2019 年 12 月 31 日作为随访期结束的时间。我们实施了调整后的 Cox 比例风险模型，按诊断时的年龄、性别和癌症分期进行分层，以检查生存率。
在我们的队列中包括了 38788 名被诊断患有肺癌的患者，其中 7%为移民。移民患者的诊断年龄较小，而且比长期居民更有可能居住在收入最低的五分位数街区（30.6%比 24.5%）。在调整了诊断时的年龄、街区收入五分位数、合并症、诊断前 6 至 30 个月的初级保健就诊次数、连续性护理、癌症类型和诊断时的癌症分期后，与长期居民相比，移民身份与女性（0.7；95%置信区间 0.6-0.8）和男性（0.7；95%置信区间 0.6-0.7）在诊断后 5 年的死亡风险较低相关。这一趋势在按诊断时的癌症分期分层的调整模型中仍然存在。例如，与长期居民相比，被诊断为早期肺癌的女性移民的风险比为 0.5（95%置信区间 0.4-0.7）。
与安大略省的长期居民相比，被诊断患有肺癌的移民的总生存率更好。需要进一步研究，可能是关于移民飞地的保护作用以及移民身份与种族/民族认同的交叉点，以进一步探讨为什么移民的总体生存率更好。
