title: Trends in mortality after cancer diagnosis: A nationwide cohort study over 45 years of follow-up in Sweden by country of birth.
abstract: BACKGROUND
  Survival has steadily improved for major cancer types in most parts of the world. We compared all-cause mortality between foreign-born and Sweden-born residents of Sweden who were diagnosed with cancer of the colon, lung, stomach, prostate, breast, cervix, and all site.
  
  
  METHODS
  We used Swedish national vital status and health registers to follow a cohort of 1,556,108 patients 45 years of age and older diagnosed with cancer between 1961 and 2009 in Sweden. Among them, 109,915 were born abroad. We estimated hazard ratios (HR) and 95% confidence interval (CI) using multivariable Cox proportional hazard models.
  
  
  RESULTS
  We identified 604,035 and 540,138 deaths among men and women, respectively. Among them 33,595 men and 34,174 women were born abroad. At the time of diagnosis, patients born abroad were on average 4 years younger than patients born in Sweden. All-cause mortality was generally lower in the former than in the latter group of patients before 1990 but higher after 2000. The mortality trend was similar for prostate and breast cancer.
  
  
  CONCLUSIONS
  Whilst national policy in Sweden aims at achieving equal access to health care, the mortality trend observed among cancer patients born in Sweden was different from that observed among patients born elsewhere. Mortality after diagnosis of major types of cancer has worsened among foreign-born after the year 2000. The possible determinants of disparities need be identified and investigated.
authors.affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Biostatistics and Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran. Electronic address: gholamreza.abdoli@ki.se.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Abdoli
authors.affiliation: Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bottai
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Sidorchuk
authors.affiliation: Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centrum for Epidemiology and Social Medicine, Healthcare Provision, Stockholm County, Sweden.
authors.forename: Tahereh
authors.initials: T
authors.lastname: Moradi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D013548:Sweden / Q000453:epidemiology
keywords: Cancer survival; Immigrants; Migration status; Population-based study; Sweden