Cancer
Volume 124, Issue 7, 2018, Pages 1473-1482

Chinese and South Asian ethnicity, immigration status, and clinical cancer outcomes in the Ontario Cancer System (Article) (Open Access)

Stevenson J.K.R. , Cheung M.C. , Earle C.C. , Fischer H.D. , Camacho X. , Saskin R. , Shah B.R. , Austin P.C. , Singh S.*
  • a Department of Medicine, University of Toronto, Toronto, ON, Canada
  • b Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
  • c Department of Medicine, University of Toronto, Toronto, ON, Canada, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Ontario Institute for Cancer Research, Toronto, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • d Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • f Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • g Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, ON, Canada
  • h Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
  • i Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada

Abstract

BACKGROUND: In the United States, certain minority groups have been shown to have inferior cancer outcomes compared with the white majority population. However, to the authors' knowledge, the majority of research has not separated ethnicity from immigration status. The objective of the current study was to determine the impact of ethnicity, independent of immigration status, on cancer outcomes in Chinese and South Asian populations in Ontario, Canada. METHODS: The authors conducted a population-based retrospective cohort study using administrative databases in Ontario, Canada. Incident cancer cases were captured in Canadian-born Chinese and South Asian individuals, Chinese and South Asian immigrants, and the general Ontario reference population (non-Chinese/non-South Asian and non-immigrant) between 2000 and 2012. Subjects were followed until death (all-cause and cancer-specific), and Cox proportional hazard models were used to estimate the impact of Chinese and South Asian ethnicity on cancer outcomes after adjusting for explanatory variables. RESULTS: A total of 423,678 cancer cases were identified; at total of 6631 cases were identified in Canadian-born Chinese individuals and 2752 cases in Canadian-born South Asian individuals. After adjustment, the rate of all-cause mortality was lower for Canadian-born Chinese (hazard ratio [HR], 0.829; 95% confidence interval [95% CI], 0.795-0.865), Canadian-born South Asian (HR, 0.856; 95% CI, 0.797-0.919), and Chinese immigrant (recent immigrant: HR, 0.661 [95% CI, 0.610-0.716] and non-recent immigrant: HR, 0.853 [95% CI, 0.803-0.906]) populations compared with the general Ontario population. A similar effect was found for cancer-specific mortality. CONCLUSIONS: Chinese and South Asian ethnic groups appear to have lower cancer mortalities compared with the general Ontario population. After removing the well-documented protective effect of immigration, Chinese and South Asian ethnicities were found to be associated with a cancer survival advantage in Ontario, Canada. Cancer 2018;124:1473-82. © 2018 American Cancer Society. © 2018 American Cancer Society

Author Keywords

Chinese cancer survival Ethnicity South Asian Immigration

Index Keywords

Chinese cancer prognosis South Asian survival rate all cause mortality neoplasm Follow-Up Studies follow up Neoplasms human immigration comorbidity middle aged Asian continental ancestry group Ethnic Groups statistics and numerical data ethnic group controlled study priority journal Aged ethnology prognosis Humans male Canada female population research antineoplastic agent cancer registry Canadian Article cancer mortality Retrospective Studies Ontario major clinical study adult migration cohort analysis Emigration and Immigration ethnicity retrospective study mortality malignant neoplasm
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85040254918&doi=10.1002%2fcncr.31231&partnerID=40&md5=a161aac317b68a72e7539dec9b8d06d4
DOI: 10.1002/cncr.31231
ISSN: 0008543X
Cited by: 2
Original Language: English