Ethnic differences in colon cancer care in the Netherlands: a nationwide registry-based study

Abstract

BackgroundEthnic differences in colon cancer (CC) care were shown in the United States, but results are not directly applicable to European countries due to fundamental healthcare system differences. This is the first study addressing ethnic differences in treatment and survival for CC in the Netherlands.MethodsData of 101,882 patients diagnosed with CC in 1996–2011 were selected from the Netherlands Cancer Registry and linked to databases from Statistics Netherlands. Ethnic differences in lymph node (LN) evaluation, anastomotic leakage and adjuvant chemotherapy were analysed using stepwise logistic regression models. Stepwise Cox regression was used to examine the influence of ethnic differences in adjuvant chemotherapy on 5-year all-cause and colorectal cancer-specific survival.ResultsAdequate LN evaluation was significantly more likely for patients from ‘other Western’ countries than for the Dutch (OR 1.09; 95% CI 1.01–1.16). ‘Other Western’ patients had a significantly higher risk of anastomotic leakage after resection (OR 1.24; 95% CI 1.05–1.47). Patients of Moroccan origin were significantly less likely to receive adjuvant chemotherapy (OR 0.27; 95% CI 0.13–0.59). Ethnic differences were not fully explained by differences in socioeconomic and hospital-related characteristics. The higher 5-year all-cause mortality of Moroccan patients (HR 1.64; 95% CI 1.03–2.61) was statistically explained by differences in adjuvant chemotherapy receipt.ConclusionThese results suggest the presence of ethnic inequalities in CC care in the Netherlands. We recommend further analysis of the role of comorbidity, communication in patient-provider interaction and patients’ health literacy when looking at ethnic differences in treatment for CC.

Income inequality and access to advanced immunotherapy for lung cancer: the case of Durvalumab in the Netherlands

“…26 For example, in the Netherlands non-Western ethnic groups have been shown to receive adjuvant chemotherapy for colon cancer less, which cannot be explained away by SES. 27 Therefore, a potentially mutual influence between SES and ethnicity and their combined effect on Durvalumab (or other immunotherapies) could be studied in future research.…”

Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds

“…The Netherlands has a legal obligation for its citizens to have healthcare insurance and to provide equal access to healthcare services. [1][2][3][4][5] Nonetheless, ethnic health disparities persist, and people with a migration background have poorer health outcomes than the native population. [1][2][3][4][5] The non-European migrant population accounts for approximately 14.5% of the population of the Netherlands, primarily comprising individuals from Morocco, Türkiye, Suriname, Indonesia and the Dutch Antilles.…”

“…[1][2][3][4][5] Nonetheless, ethnic health disparities persist, and people with a migration background have poorer health outcomes than the native population. [1][2][3][4][5] The non-European migrant population accounts for approximately 14.5% of the population of the Netherlands, primarily comprising individuals from Morocco, Türkiye, Suriname, Indonesia and the Dutch Antilles. 4 This population group is at higher risk for and shows a higher prevalence of mental health problems, communicable and non-communicable diseases and higher mortality rates than those with a Western or Dutch ethnic background.…”

“…4 This population group is at higher risk for and shows a higher prevalence of mental health problems, communicable and non-communicable diseases and higher mortality rates than those with a Western or Dutch ethnic background. [1][2][3][4] Various factors contribute to ethnic health disparities, including contextual variables such as educational level, access to healthcare services, community health and factors related to the healthcare provider and patient. While current literature often attributes ethnic health inequities to low socioeconomic status, ethnic background and comorbidities such as obesity and diabetes, 5 6 disparities persist even…”

Variations in the Type of Adjuvant Chemotherapy Among Stage III Colon Cancer Patients in England

“…Certain biological, physiological, or genetic predispositions cause differences in the rate at which certain cancers occur in subgroups, their aggressive or benign nature, or their response to treatment [2][3][4]. Moreover, there are many demographic and socioeconomic factors that can result in differences in survival, including age, race, sex, deprivation, and comorbidities [5][6][7][8]. Reasons for these variations in survival between groups could be due to more advanced disease resulting from delayed diagnosis [9,10].…”