Preventive Medicine
Volume 111, 2018, Pages 180-189

Predictors of non-adherence to colorectal cancer screening among immigrants to Ontario, Canada: a population-based study (Article)

Shen S.C.* , Lofters A. , Tinmouth J. , Paszat L. , Rabeneck L. , Glazier R.H.
  • a Dalla Lana School of Public Health, Toronto, Ontario, Canada
  • b Dalla Lana School of Public Health, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
  • c Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
  • d Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada, Department of Radiation Oncology, University of Toronto, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Division of Gastroenterology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, Department of Medicine, University of Toronto, Toronto, Ontario, Canada, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
  • f Dalla Lana School of Public Health, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada

Abstract

Though colorectal cancer (CRC) screening rates have increased over time in Ontario, Canada, immigrants continue to have lower rates of screening. This study examines the association between non-adherence to CRC screening and immigration, socio-demographic, healthcare utilization, and primary care physician characteristics among immigrants to Ontario. This is a population-based retrospective cross-sectional study that uses healthcare administrative databases housed at the Institute for Clinical Evaluative Sciences. Our cohort comprised immigrants aged 60 to 74 years who lived in Ontario on March 31, 2015 and who had been eligible for the Ontario Health Insurance Plan for at least 10 years. The outcome was lack of adherence to CRC screening with any modality (fecal occult blood test, flexible sigmoidoscopy, colonoscopy) on March 31, 2015. Our cohort contained 182,949 immigrants. Overall 70,134 (38%) individuals were not adherent to screening. Risk of non-adherence to CRC screening was higher among immigrants who were from low (adjusted relative risk [ARR] 1.35, 95%CI 1.28–1.42) or low-middle (ARR 1.27, 95%CI 1.24–1.30, population-attributable risk [PAR] 9.8%) income countries and refugees (ARR 1.09, 95%CI 1.06–1.11). Compared to those from the United States, Australia, and New Zealand, immigrants from most other world regions, particularly Eastern Europe and Central Asia (ARR 1.28, 95%CI 1.21–1.37), had higher risks of non-adherence. Non-immigration factors such as low healthcare use and lack of primary care enrolment also increased the risk of non-adherence to screening. These findings can be used to inform future efforts to improve uptake of CRC screening among immigrant groups. © 2018 Elsevier Inc.

Author Keywords

immigrants Early detection of cancer Secondary prevention Colorectal cancer Cancer screening

Index Keywords

immigrant refugee Australia mass screening demography Europe human immigration middle aged Asia middle income country colorectal cancer colorectal tumor statistics and numerical data controlled study priority journal early cancer diagnosis Aged Colorectal Neoplasms cancer screening Eastern Europe geographic distribution Asia, Central country economic status low middle income country Early Detection of Cancer ethnology sigmoidoscopy refusal to participate Cross-Sectional Studies United States population risk cross-sectional study migrant Humans male Canada Emigrants and Immigrants female colonoscopy risk factor population research Article Retrospective Studies health care utilization Ontario physician attitude adult New Zealand patient attitude low income country cohort analysis Patient Acceptance of Health Care Central Asian retrospective study
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85043992286&doi=10.1016%2fj.ypmed.2018.03.002&partnerID=40&md5=ad19b7087d739d8223ba0a5ea89084cd
DOI: 10.1016/j.ypmed.2018.03.002
ISSN: 00917435
Cited by: 5
Original Language: English