Differences in cancer survival between immigrants in Norway and the host population

Thøgersen, Håvard; Møller, Bjørn; Robsahm, Trude Eid; Babigumira, Ronnie; Aaserud, Stein; Larsen, Inger Kristin

doi:10.1002/ijc.31729

Cited by 12 publications

(10 citation statements)

References 35 publications

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“…Thus, acculturation over time to Western lifestyle habits, with less-favourable fat intake, may contribute to the loss of mortality advantage in second-generation immigrants. The beneficial cancer survival rates observed in firstgeneration non-Western immigrants (in particular, Middle Eastern immigrants) is consistent with previous register data on non-Western immigrants to Norway [38]. Insulin-resistant diabetes is reported to be associated with morbidity in cancer [39].…”

Section: Discussionsupporting

confidence: 89%

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

et al. 2020

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Aims/hypothesis Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes. Methods People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis. Results In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]). Conclusions/interpretation In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed.

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Section: Discussionsupporting

confidence: 89%

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

et al. 2020

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“…Koyi et al and Norredam et al found no significant differences in lung cancer mortality between native born and immigrant patients in Sweden and Denmark [ 7 , 28 ]. Similar to our findings, a lower lung cancer mortality in immigrants has been reported from Norway [ 27 ]. Based on the results of the adjusted analyses in our study, we conclude that the better prognosis in Non-Nordic immigrants most likely reflect younger age at diagnosis.…”

Section: Discussionsupporting

confidence: 93%

Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden)

Willén

Berglund²,

Bergström

et al. 2022

PLoS ONE

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Objectives While studies have found lower cancer risks and better cancer survival in immigrant populations, it is debated whether cancer care is offered on equal terms to all residents regardless of background. Our aim was to study patterns of care and outcomes in immigrants in a country with a tax-financed universal health care system. Material and methods We used a population-based database to compare clinical presentation, management and mortality between Swedish-born and immigrant patients with non-small cell lung cancer (NSCLC). Analyses were adjusted for potential confounders. Results We identified 40,075 patients diagnosed with NSCLC of which 84% were born in Sweden, 7% in Nordic and 9% in Non-Nordic countries. Non-Nordic immigrants were to a higher extent male, smokers, younger at diagnosis, had a better performance status and a higher educational level. No differences were seen regarding comorbidity burden or stage at diagnosis. Non-Nordic immigrants more often underwent positron emission tomography (PET) (aHR 1.32; 95% CI 1.19–1.45) and were more often discussed in a multidisciplinary team setting (aHR 1.30; 95% CI 1.17–1.44). There were no differences in treatment modalities following adjustment for age, with the exception of concurrent chemoradiotherapy in stage IIIA disease which was more common in Non-Nordic immigrants (aOR 1.34; 95% CI 1.03–1.74). Both overall and cause specific survival in non-metastatic disease were higher among Non-Nordic immigrants. Overall mortality in stage I-II: HR 0.81; 95% CI 0.73–0.90 and stage IIIA: HR 0.75; 95% CI 0.65–0.86. Following full adjustments, cause-specific mortality in stage I-II was aHR 0.86, 95% CI 0.75–0.98. Conclusion Taken together, only minor differences in management and outcomes were observed between Swedish-born and immigrant patients. We conclude that lung cancer care is offered on equal terms. If anything, outcomes were better in Non-Nordic immigrants with early stage NSCLC.

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“…Differences in incidence between non-immigrants and immigrants have also been shown by others, both in Sweden [7,8] and Denmark [9]. Results from studies on survival points towards similar or better survival in immigrants compared to the non-immigrant populations in Norway, Sweden and Denmark [17][18][19][20], with some exceptions in breast cancer and melanoma [7,19,20].…”

Section: Discussionmentioning

confidence: 68%

Cancer incidence in non-immigrants and immigrants in Norway

et al. 2020

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Background: Major cancers are associated with lifestyle, and previous studies have found that the non-immigrant populations in the Nordic countries have higher incidence rates of most cancers than the immigrant populations. However, rates are changing worldwideso these differences may disappear with time. Here we present recent cancer incidence rates among immigrant and non-immigrant men and women in Norway and investigate whether previous differences still exist. Material and methods: We took advantage of a recent change in the Norwegian Cancer Registry regulations that allow for the registry to have information on country of birth. The number of person years for 2014-2018 was aggregated for every combination of sex, five-year age-group and country of birth, by summing up each year's population in these groups. The number of cancer cases was then counted for the same groups, and age-standardised incidence rates calculated by weighing the agespecific incidence rates by the Nordic and World standard populations. Further, we calculated incidence rate ratios using the non-immigrant population as a reference. Results: Immigrants from Eastern Europe, the Middle East, Africa and Asia had lower incidence of total cancer compared to the non-immigrant population in Norway and immigrants born in the other Nordic or high-income countries. However, some cancers were more common in certain immigrant groups. Asian men and women had threefold the incidence of liver cancer than non-immigrant men and women. Men from the other Nordic countries and from Eastern Europe had higher lung cancer rates than non-immigrant men. Conclusion: National registries should continuously monitor and present cancer incidence stratified on important population subgroups such as country of birth. This can help assess population subgroup specific needs for cancer prevention and treatment, and could eventually help reduce the morbidity and mortality of cancer.

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Differences in cancer survival between immigrants in Norway and the host population

Cited by 12 publications

References 35 publications

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden)

Cancer incidence in non-immigrants and immigrants in Norway

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