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Article

Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada

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Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
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Women’s College Hospital Research Institute, Toronto, ON M5S 1B2, Canada
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Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
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ICES, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
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MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
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Melbourne School of Population and Global Health, University of Melbourne, Victoria 3053, Australia
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Department of Surgery, University of Toronto, Toronto, ON M5T 1P5, Canada
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Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1W8, Canada
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Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
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Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON M5B 1Z5, Canada
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Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC H3N 1X9, Canada
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Research Center of the University of Montreal Hospital Center (CR-CHUM), Montréal, QC H2X 0A9, Canada
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Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA 90069, USA
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(3), 1946-1956; https://doi.org/10.3390/curroncol28030181
Received: 7 April 2021 / Revised: 6 May 2021 / Accepted: 13 May 2021 / Published: 23 May 2021
Lung cancer is the most common cancer and cause of cancer death in Canada, with approximately 50% of cases diagnosed at stage IV. Sociodemographic inequalities in lung cancer diagnosis have been documented, but it is not known if inequalities exist with respect to immigration status. We used multiple linked health-administrative databases to create a cohort of Ontarians 40–105 years of age who were diagnosed with an incident lung cancer between 1 April 2012 and 31 March 2017. We used modified Poisson regression with robust standard errors to examine the risk of diagnosis at late vs. early stage among immigrants compared to long-term residents. The fully adjusted model included age, sex, neighborhood-area income quintile, number of Aggregated Diagnosis Group (ADG) comorbidities, cancer type, number of prior primary care visits, and continuity of care. Approximately 62% of 38,788 people with an incident lung cancer from 2012 to 2017 were diagnosed at a late stage. Immigrants to the province were no more likely to have a late-stage diagnosis than long-term residents (63.5% vs. 62.0%, relative risk (RR): 1.01 (95% confidence interval (CI): 0.99–1.04), adjusted relative risk (ARR): 1.02 (95% CI: 0.99–1.05)). However, in fully adjusted models, people with more comorbidities were less likely to have a late-stage diagnosis (adjusted relative risk (ARR): 0.82 (95% CI: 0.80–0.84) for those with 10+ vs. 0–5 ADGs). Compared to adenocarcinoma, small cell carcinoma was more likely to be diagnosed at a late stage (ARR: 1.29; 95% CI: 1.27–1.31), and squamous cell (ARR: 0.89; 95% CI: 0.87–0.91) and other lung cancers (ARR: 0.93; 95% CI: 0.91–0.94) were more likely to be diagnosed at an early stage. Men were also slightly more likely to have late-stage diagnosis in the fully adjusted model (ARR: 1.08; 95% CI: 1.05–1.08). Lung cancer in Ontario is a high-fatality cancer that is frequently diagnosed at a late stage. Having fewer comorbidities and being diagnosed with small cell carcinoma was associated with a late-stage diagnosis. The former group may have less health system contact, and the latter group has the lung cancer type most closely associated with smoking. As lung cancer screening programs start to be implemented across Canada, targeted outreach to men and to smokers, increasing awareness about screening, and connecting every Canadian with primary care should be system priorities. View Full-Text
Keywords: lung cancer; screening; immigrant health lung cancer; screening; immigrant health
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Figure 1

MDPI and ACS Style

Lofters, A.K.; Gatov, E.; Lu, H.; Baxter, N.N.; Guilcher, S.J.T.; Kopp, A.; Vahabi, M.; Datta, G.D. Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada. Curr. Oncol. 2021, 28, 1946-1956. https://doi.org/10.3390/curroncol28030181

AMA Style

Lofters AK, Gatov E, Lu H, Baxter NN, Guilcher SJT, Kopp A, Vahabi M, Datta GD. Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada. Current Oncology. 2021; 28(3):1946-1956. https://doi.org/10.3390/curroncol28030181

Chicago/Turabian Style

Lofters, Aisha K.; Gatov, Evgenia; Lu, Hong; Baxter, Nancy N.; Guilcher, Sara J.T.; Kopp, Alexander; Vahabi, Mandana; Datta, Geetanjali D. 2021. "Lung Cancer Inequalities in Stage of Diagnosis in Ontario, Canada" Curr. Oncol. 28, no. 3: 1946-1956. https://doi.org/10.3390/curroncol28030181

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