title: Differences in stage of disease between migrant women and native Danish women diagnosed with cancer: results from a population-based cohort study.
abstract: The aim of the study is to compare differences in cancer stage at diagnosis between migrant women and native Danish women. The stage is used as a clinical indicator of access to healthcare until the point of diagnosis. Refugees and family reunited migrants who received residence permits in Denmark from 1 January 1993 to 31 December 1999 were included and matched 1 : 4 on age and sex with a Danish-born reference population. Our final female population included 24 734 migrants and 123 670 controls. Civil registration numbers of the cohort were linked to the Danish Cancer Registry whereby cases were identified in the period 1.1.1993-31.12.2002. Only women from Eastern Europe and the Middle East were included. This amounted to 269 migrants and 1608 native Danes. Data from the Danish Cancer Registry included diagnosis, time of diagnosis and disease stage at diagnosis. Our initial analyses of migrant subgroups showed that migrant women had decreased odds ratios of being diagnosed at the local stage and increased odds of having unknown stage, although these tendencies were mainly not statistically significant. A subsequent analysis of an overall migrant effect on all cancer sites emphasized these tendencies. This analysis reached borderline significance for local versus nonlocal stage and significance for unknown versus known stage. Our results indicate that migrant women may experience barriers in access to healthcare until cancer diagnosis compared with Danish women. More research is, however, needed to confirm our results and to find out if they indicate general problems concerning migrants' access to healthcare in Denmark.
authors.affiliation: Department of Health Services Research and Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. m.norredam@pubhealth.ku.dk
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
authors.forename: Allan
authors.initials: A
authors.lastname: Krasnik
authors.forename: Christian
authors.initials: C
authors.lastname: Pipper
authors.forename: Niels
authors.initials: N
authors.lastname: Keiding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D044382:Population Groups / Q000706:statistics & numerical data; D012042:Registries; D014171:Transients and Migrants / Q000706:statistics & numerical data