Abstract
In 2010, cancer deaths accounted for more than 15% of all deaths worldwide, and this fraction is estimated to rise in the coming years. Increased cancer mortality has been observed in immigrant populations, but a comprehensive analysis by country of birth has not been conducted. We followed all individuals living in Sweden between 1961 and 2009 (7,109,327 men and 6,958,714 women), and calculated crude cancer mortality rates and age-standardized rates (ASRs) using the world population for standardization. We observed a downward trend in all-site ASRs over the past two decades in men regardless of country of birth but no such trend was found in women. All-site cancer mortality increased with decreasing levels of education regardless of sex and country of birth (p for trend <0.001). We also compared cancer mortality rates among foreign-born (13.9%) and Sweden-born (86.1%) individuals and determined the effect of education level and sex estimated by mortality rate ratios (MRRs) using multivariable Poisson regression. All-site cancer mortality was slightly higher among foreign-born than Sweden-born men (MRR = 1.05, 95% confidence interval 1.04–1.07), but similar mortality risks was found among foreign-born and Sweden-born women. Men born in Angola, Laos, and Cambodia had the highest cancer mortality risk. Women born in all countries except Iceland, Denmark, and Mexico had a similar or smaller risk than women born in Sweden. Cancer-specific mortality analysis showed an increased risk for cervical and lung cancer in both sexes but a decreased risk for colon, breast, and prostate cancer mortality among foreign-born compared with Sweden-born individuals. Further studies are required to fully understand the causes of the observed inequalities in mortality across levels of education and countries of birth.
Highlights
Worldwide, in 2010 there were 8 million deaths due to cancer, accounting for 15.1% of all deaths [1]
We evaluated the risks of mortality due to all-site cancer and to some common specific cancers in the total Swedish population and in subgroups of the large and currently increasing foreign-born population by individual birth country, sex, and socioeconomic position (SEP)
Because composition of the education groups might have changed over time, we further evaluated the effect of education on all-site cancer mortality separately by decades of calendar time (1961–1970, ..., 2001– 2009)
Summary
In 2010 there were 8 million deaths due to cancer, accounting for 15.1% of all deaths [1]. 20% of all deaths in Europe are due to cancer, with more than 1.7 million annual deaths [3]. Cancer is the second most common cause of mortality in Sweden (26% of deaths among men and 22% among women) [4] and contributes to 60% of the total burden of disease [5]. Because of the increasing number of transnational migrants, estimated at 3.1% of the global population in 2010 [9], focused research is needed among immigrant populations worldwide to investigate, for example, the etiology of diseases, gene–environment interactions, potential inequalities with respect to access to healthcare services, and treatments of interest from a healthcare perspective to better optimize the use of resources. Useful information regarding the impact of environmental factors on mortality could be gained through investigation of cancer mortality among foreign-born individuals [10]
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