Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada

A K Lofters,A K Lofters,A K Lofters,A K Lofters,A K Lofters,A M Corrado,G D Datta,S J T Guilcher,S J T Guilcher,H Lu,S J T Guilcher,G D Datta,M Vahabi,M Vahabi,E Gatov,N N Baxter,N N Baxter,A Kopp

doi:10.1007/s10552-021-01491-5

Abstract

BackgroundColorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada’s most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known.MethodsWe utilized linked administrative databases to compare early (stage I–II) versus late (stage III–IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage.ResultsAlmost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02–1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83–0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03–1.12)].ConclusionImmigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage.ImpactAttachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.

Highlights

Colorectal cancer (CRC) is the second most common cancer and the second most common cause of cancer death in Canada, with approximately 10,000 deaths per year [1]
Of 41,887 patients identified with CRC between 2012 and 2017, there were 37,717 people included in the final cohort, 3,513 (9.3%) of whom were identified as immigrants (Fig. 1)
Age at diagnosis was significantly different between immigrants and long-term residents, with immigrants diagnosed at 62.6 years on average versus 70.1 years for long-term residents [standardized difference (SD) = 0.55]

Summary

Introduction

Colorectal cancer (CRC) is the second most common cancer and the second most common cause of cancer death in Canada, with approximately 10,000 deaths per year [1]. Regardless of modality used, rates of CRC screening in the province are currently suboptimal, with an estimated 39% of eligible Ontarians overdue for screening [4] This suboptimal uptake is of particular relevance considering that it has been estimated that CRC deaths can be reduced by 13% with regular fecal screening [5]. Immigrants in Ontario, Canada’s most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. Conclusion Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. Impact Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and should be a healthcare system priority

Methods

Results

Conclusion