Comparing stage of diagnosis of cervical cancer at presentation in immigrant women and long-term residents of Ontario: a retrospective cohort study

Teja Voruganti; Rahim Moineddin; Nathaniel Jembere; Laurie Elit; Eva Grunfeld; Aisha K. Lofters

doi:10.9778/cmajo.20160029

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Selection of study cohort.

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Table 1: Characteristics of women in the study cohort with cervical cancer diagnosed in Ontario in 2010-2014

Characteristic	No. (%)*
Characteristic	Immigrants (n = 345)	Long-term residents (n = 1380)	Standardized mean difference†
Age, yr, mean ± SD	52 ± 14.7	52 ± 14.7	0.03
Neighbourhood income quintile
1 (lowest)	96 (27.8)	304 (22.0)	0.3
2	93 (27.0)	271 (19.6)
3	47 (13.6)	278 (20.1)
4	64 (18.6)	271 (19.6)
5 (highest)	44 (12.8)	247 (17.9)
Missing data	< 5 (NA)	< 5 (NA)
Rurality index
Major urban	332 (96.0)	937 (67.9)	0.9
Nonmajor urban	< 5 (NA)	324 (23.5)
Rural	< 5 (NA)	108 (7.8)
Missing data	< 5 (NA)	8 (0.6)
Aggregated diagnosis group
0 (no comorbidity)	23 (6.7)	108 (7.8)	0.1
1-5	163 (47.2)	655 (47.4)
6-9	105 (30.4)	445 (32.2)
≥ 10 (high comorbidity)	54 (15.7)	172 (12.5)
Time since last screening, yr
> 3	126 (36.5)	465 (33.7)	0.1
3-5	32 (9.3)	162 (11.7)
> 5	11 (3.2)	38 (2.8)
Never screened	174 (50.4)	715 (51.8)
Visit to gynecologist in past 3 yr
Yes	204 (59.1)	788 (57.1)	0.04
No	141 (40.9)	592 (42.9)
Missing data	-	-
No. of health contacts in past 3 yr, mean ± SD	30.7 ± 25.3	29.0 ± 30.3	0.05
Diagnosis of HIV	< 5 (NA)	< 5 (NA)	-
Family physician sex
Female	118 (34.2)	507 (36.7)	0.2
Male	222 (64.3)	798 (57.8)
Missing data	6 (1.7)	64 (4.6)
Family physician is an international medical graduate
Yes	154 (44.6)	250 (18.1)	0.6
No	186 (53.9)	1066 (77.2)
Missing data	6 (1.7)	64 (4.6)
Family physician in a patient enrollment model
Yes	296 (85.8)	1207 (87.5)	0.3
No	45 (13.0)	112 (8.1)
Missing data	< 5 (NA)	61 (4.4)

Note: NA = not available.

*Unless otherwise specified.

†Values > 0.1 are considered important differences.

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Table 2: Characteristics of immigrant women in Ontario with a diagnosis of cervical cancer

Characteristic	Cervical cancer, no. (%)n = 345
Characteristic	Overall	No known stage	Early stage	Late stage
Immigrant class
Economic	134 (38.8)	43 (33.9)	55 (46.6)	36 (36.0)
Family	162 (47.0)	64 (50.4)	45 (38.1)	53 (53.0)
Refugee with landing visa	48 (13.9)	19 (15.0)	18 (15.3)	11 (11.0)
Other	< 5 (NA)	< 5 (NA)	-	-
Language ability
English or French	195 (56.5)	75 (59.1)	71 (60.2)	49 (49.0)
Other	150 (43.5)	52 (40.9)	47 (39.8)	51 (51.0)
Region of origin
Africa	8 (2.3)	< 5 (NA)	6 (5.1)	< 5 (NA)
Caribbean	26 (7.5)	11 (8.7)	9 (7.6)	6 (6.0)
East Asia	117 (34.2)	40 (31.5)	46 (39.0)	31 (31.0)
Latin America	29 (8.4)	10 (7.9)	11 (9.3)	8 (8.0)
Middle East	20 (5.8)	12 (9.4)	< 5 (NA)	< 5 (NA)
South Asia	48 (13.9)	22 (17.3)	< 5 (NA)	22 (22.0)
Western Europe and USA	94 (27.2)	30 (23.6)	36 (30.5)	28 (28.0)

Note: NA = not available.

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Table 3: Bivariate and multivariate analysis showing unadjusted and adjusted odds ratios with respect to the probability of late stage versus early stage for the study cohort

Characteristic	Unadjusted OR (95% CI)	p value	Adjusted OR (95% CI)	p value
Immigrant status
Long-term resident	0.99 (0.70-1.40)	0.9	0.94 (0.63-1.39)	0.7
Immigrant	1.00	0.9	1.00	0.7
Income quintile
1 (lowest)	0.85 (0.54-1.36)	0.8	0.87 (0.53-1.43)	0.6
2	1.02 (0.62-1.67)		0.99 (0.58-1.70)
3	0.86 (0.53-1.41)		0.92 (0.54-1.58)
4	1.05 (0.64-1.73)		1.33 (0.78-2.27)
5 (highest)	1.00		1.00
Rurality index
Rural	0.98 (0.53-1.80)	< 1.0	0.94 (0.45-1.93)	0.7
Nonmajor urban	0.95 (0.67-1.38)		0.85 (0.55-1.30)
Major urban	1.00		1.00
Aggregated diagnosis group
0 (no comorbidity)	3.29 (1.51-7.15)	0.0006	1.66 (0.60-4.59)	0.2
1-5	1.50 (0.93-2.43)		1.18 (0.61-2.27)
6-9	0.88 (0.52-1.48)		0.78 (0.42-1.45)
≥ 10 (high comorbidity)	1.00		1.00
Time since last screening, yr*
> 3	0.41 (0.29-0.59)	< 0.0001	-	-
3-5	0.48 (0.28-0.81)
> 5	1.88 (0.54-6.54)
Never screened	1.00
Visit to gynecologist in the past 3 yr
No	2.73 (2.00-3.73)	< 0.0001	2.47 (1.8-3.50)	< 0.0001
Yes	1.00	< 0.0001	1.00	< 0.0001
Family physician sex
Female	0.69 (0.50-0.95)	0.02	0.71 (0.50-1.00)	0.06
Male	1.00	0.02	1.00	0.06
Family physician in a patient enrolment model
No	1.65 (0.99-2.77)	0.06	1.72 (0.98-3.00)	0.06
Yes	1.00	0.06	1.00	0.06
No. of health care contacts in past 3 yr	0.99 (0.97-1.00)	0.01	1.00 (0.99-1.01)	0.9