Cancer Medicine
Volume 8, Issue 16, 2019, Pages 7108-7122

Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada (Article) (Open Access)

Vahabi M.* , Lofters A. , Wong J.P.-H. , Ellison L. , Graves E. , Damba C. , Glazier R.H.
  • a Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada, Graduate Program in Immigration and Settlement Studies, Ryerson University, Toronto, ON, Canada, Ryerson Centre for Global Health and Health Equity, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • b Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada, Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • c Faculty of Community Services, Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • d Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • f Toronto Central Local Health Integration, Toronto, ON, Canada
  • g Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada, Department of Family and Community Medicine, St. Michael Hospital, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Abstract

Background: Colorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population-based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants. Methods: We conducted a population-based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50-74 who were eligible for FOBT from 1 April 2013 to 31 March 2015. Results: We found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim-majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90-0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim-majority countries. Conclusions: These findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information. © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Author Keywords

social determinants of health fecal occult blood test access to primary care Region of origin Colorectal cancer Muslim immigrants

Index Keywords

Cultural Diversity immigrant primary medical care health care personnel human colorectal cancer controlled study priority journal Aged cancer screening clinical practice income Muslim social status male Canada occult blood test female risk factor Article adult gender physician health care access cohort analysis retrospective study
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073978904&doi=10.1002%2fcam4.2541&partnerID=40&md5=3981b119a3ad2c0931484d17050b318c
DOI: 10.1002/cam4.2541
ISSN: 20457634
Original Language: English