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Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study

Aisha K. Lofters, Jacqueline L. Bender, Sarah Swayze, Shabbir Alibhai, Anthony Henry, Kenneth Noel and Geetanjali D. Datta
November 01, 2022 10 (4) E956-E963; DOI: https://doi.org/10.9778/cmajo.20220069
Aisha K. Lofters
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
MD PhD
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Jacqueline L. Bender
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
PhD
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Sarah Swayze
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
MSc
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Shabbir Alibhai
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
MD MSc
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Anthony Henry
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
BA
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Kenneth Noel
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
BSc
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Geetanjali D. Datta
Peter Gilgan Centre for Women’s Cancers (Lofters), Women’s College Hospital; Department of Family and Community Medicine (Lofters), University of Toronto; Cancer Rehabilitation and Survivorship (Bender), Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network; ICES (Lofters, Swayze); Dalla Lana School of Public Health (Bender), University of Toronto; Department of Medicine and Institute of Health Policy, Management, and Evaluation (Alibhai), University of Toronto; Department of Medicine (Alibhai), University Health Network; Institute of Health Policy, Management and Evaluation (Bender), University of Toronto; ; Walnut Foundation (Henry, Noel), Toronto, Ont.; Department of Medicine (Datta), Cedar-Sinai Medical Center; Cancer Research Center for Health Equity (Datta), Samuel Oschin Comprehensive Cancer Institute, Los Angeles, Calif.
ScD
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Article Figures & Tables

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  • Figure 1:
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    Figure 1:

    Age-standardized incidence rates per 100 000 for prostate cancer in Ontario for fiscal years 2008–2016, stratified by region of origin.

  • Figure 2:
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    Figure 2:

    Age-standardized incidence rates per 100 000 for prostate cancer for the overall cohort and stratified by region of origin, Ontario, Canada (2008–2016). Error bars represent 95% confidence intervals.

Tables

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    Table 1:

    Descriptive characteristics of overall study cohort, Ontario, Canada (2008–2016)*

    VariableCaribbean
    n = 529 651
    East Africa
    n = 289 254
    East Asia and Pacific
    n = 1 969 550
    Eastern Europe and Central Asia
    n = 1 065 676
    Latin America
    n = 634 289
    Middle East and North Africa
    n = 846 259
    Age, yr
     Mean ± SD42.9 ± 13.442.9 ± 13.646.0 ± 15.545.0 ± 14.243.9 ± 13.743.2 ± 14.6
     Median (IQR)42 (32–51)42 (32–52)45 (34–55)45 (34–55)43 (33–53)43 (31–52)
    Economic class119 936 (22.6)67 747 (23.4)1 137 941 (57.8)508 464 (47.7)181 875 (28.7)471 661 (55.7)
    Family class376 427 (71.1)51 471 (17.8)632 136 (32.1)213 367 (20.0)269 545 (42.5)136 677 (16.2)
    Refugee23 024 (4.3)165 062 (57.1)158 333 (8.0)331 121 (31.1)167 899 (26.5)228 069 (27.0)
    Other10 264 (1.9)4974 (1.7)41 140 (2.1)12 724 (1.2)14 970 (2.4)9852 (1.2)
    Income quintile
     1 (lowest)173 267 (32.7)131 476 (45.5)486 560 (24.7)233 729 (21.9)185 944 (29.3)211 773 (25.0)
     2128 653 (24.3)55 738 (19.3)479 606 (24.4)196 724 (18.5)157 504 (24.8)159 145 (18.8)
     3116 933 (22.1)43 783 (15.1)392 267 (19.9)209 583 (19.7)131 328 (20.7)161 064 (19.0)
     472 929 (13.8)36 727 (12.7)362 229 (18.4)245 483 (23.0)97 800 (15.4)178 241 (21.1)
     5 (highest)37 869 (7.1)21 530 (7.4)248 888 (12.6)180 157 (16.9)61 713 (9.7)136 036 (16.1)
    Time since landing, yr
     Mean ± SD15.4 ± 8.014.3 ± 7.913.5 ± 7.515.4 ± 7.115.3 ± 8.412.7 ± 7.6
     Median (IQR)17 (9–22)15 (8–21)13 (7–19)16 (10–21)16 (8–22)12 (6–19)
    VariableMiddle-Southern Africa
    n = 78 052
    South Asia
    n = 2 151 654
    Western Africa
    n = 146 040
    Western Europe
    n = 544 498
    US, Australia and New Zealand
    n = 153 710
    Long-term residents
    n = 36 754 786
    Total
    n = 45 163 419
    Age, yr
     Mean ± SD42.3 ± 14.144.1 ± 14.642.5 ± 12.044.5 ± 13.743.3 ± 14.448.7 ± 17.647.9 ± 17.2
     Median (IQR)41 (31–51)42 (33–53)43 (33–52)44 (34–53)42 (32–53)48 (34–62)47 (34–60)
    Economic class41 446 (53.1)1 048 987 (48.8)45 357 (31.1)323 774 (59.5)55 450 (36.1)NA4 002 638 (8.9)
    Family class12 393 (15.9)693 638 (32.2)58 951 (40.4)188 731 (34.7)92 755 (60.3)NA2 726 091 (6.0)
    Refugee21 959 (28.1)381 704 (17.7)36 406 (24.9)26 697 (4.9)3851 (2.5)NA1 544 125 (3.4)
    Other2254 (2.9)27 325 (1.3)5326 (3.6)5296 (1.0)1654 (1.1)NA135 779 (0.3)
    Income quintile
     1 (lowest)20 401 (26.1)591 574 (27.5)57 843 (39.6)90 107 (16.5)23 085 (15.0)6 535 312 (17.8)8 741 071 (19.4)
     211 884 (15.2)524 889 (24.4)33 274 (22.8)113 249 (20.8)26 812 (17.4)7 117 317 (19.4)9 004 795 (19.9)
     312 532 (16.1)510 422 (23.7)28 004 (19.2)108 795 (20.0)28 433 (18.5)7 312 052 (19.9)9 055 196 (20.0)
     414 900 (19.1)351 117 (16.3)17 577 (12.0)113 792 (20.9)31 586 (20.5)7 688 061 (20.9)9 210 442 (20.4)
     5 (highest)18 335 (23.5)173 652 (8.1)9342 (6.4)118 555 (21.8)43 794 (28.5)8 102 044 (22.0)9 151 915 (20.3)
    Time since landing, yr
     Mean ± SD13.1 ± 8.311.8± 7.012.0 ± 7.515.8 ± 8.911.4 ± 8.4NA13.6 ± 7.7
     Median (IQR)12 (6–20)11 (6–17)12 (6–18)17 (8–23)10 (4–18)NA13 (7–20)
    • Note: IQR = interquartile range, NA = not applicable, SD = standard deviation.

    • ↵* n represents person-years.

    • View popup
    Table 2:

    Age-standardized incidence rates per 100 000 for prostate cancer for the overall cohort and stratified by region of origin, Ontario, Canada (2008–2016)

    RegionAge-standardized incidence rate per 100 000 (95% CI)
    Overall cohort178.8 (177.6–180.1)
    Caribbean313.1 (289.7–337.8)
    East Africa144.0 (122.2–168.4)
    East Asia and Pacific104.0 (98.4–109.8)
    Eastern Europe and Central Asia154.1 (143.8–165.0)
    Latin America167.7 (153.1–183.3)
    Middle East and North Africa131.5 (120.7–143.0)
    Middle-Southern Africa194.0 (149.8–247.1)
    South Asia88.6 (83.3–94.1)
    Western Africa475.3 (385.7–579.4)
    Western Europe176.7 (160.7–193.9)
    US, Australia and New Zealand173.0 (143.1–207.4)
    All immigrants134.9 (131.6–138.3)
    Long-term residents184.4 (183.0–185.8)
    • Note: CI = confidence interval.

    • View popup
    Table 3:

    Adjusted incidence rate ratios for overall study population (n = 45 163 419 person-years) and for immigrants (n = 8 408 633 person-years) in the cohort only, adjusted for variables listed in the table

    VariableAdjusted rate ratio (95% CI)
    Overall study cohortImmigrants in the study cohort
    Region of origin
     Caribbean1.91 (1.78–2.04)2.06 (1.72–2.45)
     East Africa0.76 (0.66–0.88)0.85 (0.68–1.06)
     East Asia and Pacific0.55 (0.52–0.58)0.60 (0.50–0.71)
     Eastern Europe and Central Asia0.84 (0.79–0.89)0.94 (0.79–1.12)
     Latin America0.95 (0.87–1.02)1.04 (0.87–1.25)
     Middle East and North Africa0.72 (0.66–0.78)0.80 (0.66–0.95)
     Middle-Southern Africa1.14 (0.91–1.41)1.27 (0.97–1.67)
     South Asia0.47 (0.45–0.50)0.52 (0.44–0.62)
     Western Africa2.71 (2.41–3.05)3.01 (2.46–3.68)
     Western Europe0.95 (0.87–1.04)0.95 (0.87–1.04)
     US, Australia and New Zealand0.91 (0.78–1.07)1 (Ref.)
     Long-term residents1 (Ref.)–
    Income quintile
     1 (lowest)1 (Ref.)1 (Ref.)
     21.08 (1.06–1.11)1.03 (0.96–1.10)
     31.13 (1.10–1.16)1.06 (0.99–1.14)
     41.17 (1.14–1.19)1.13 (1.05–1.21)
     5 (highest)1.22 (1.20–1.25)1.11 (1.02–1.20)
    Age group, yr
     < 500.01 (0.01–0.01)0.01 (0.01–0.01)
     50–590.31 (0.30–0.32)0.30 (0.28–0.31)
     60–691 (Ref.)1 (Ref.)
     70–791.37 (1.35–1.39)1.43 (1.34–1.52)
     ≥ 801.04 (1.02–1.07)0.96 (0.87–1.06)
    Immigrant admission category
     Economic class–1 (Ref.)
     Family class–1.01 (0.95–1.07)
     Refugee–0.94 (0.87–1.01)
     Other–0.93 (0.77–1.12)
    Time since landing, yr
     0–5–1 (Ref.)
     6–10–0.77 (0.70–0.84)
     11–15–0.78 (0.71–0.85)
     16–20–0.92 (0.84–1.00)
     ≥ 21–0.88 (0.81–0.95)
    • Note: CI = confidence interval, Ref. = reference category.

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CMAJ Open: 10 (4)
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Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study
Aisha K. Lofters, Jacqueline L. Bender, Sarah Swayze, Shabbir Alibhai, Anthony Henry, Kenneth Noel, Geetanjali D. Datta
Oct 2022, 10 (4) E956-E963; DOI: 10.9778/cmajo.20220069

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Prostate cancer incidence among immigrant men in Ontario, Canada: a population-based retrospective cohort study
Aisha K. Lofters, Jacqueline L. Bender, Sarah Swayze, Shabbir Alibhai, Anthony Henry, Kenneth Noel, Geetanjali D. Datta
Oct 2022, 10 (4) E956-E963; DOI: 10.9778/cmajo.20220069
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