title: Cancer Survival Disparities Between First Nation and Non-Aboriginal Adults in Canada: Follow-up of the 1991 Census Mortality Cohort.
abstract: The burden of cancer among indigenous people in Canada has been understudied due to a lack of ethnic identifiers in cancer registries. We compared cancer survival among First Nations to that among non-Aboriginal adults in Canada in the first national study of its kind to date.
  
  
  
  A population-based cohort of approximately 2 million respondents to the 1991 Canadian Long Form Census was followed for cancer diagnoses and deaths using probabilistic linkage to cancer and death registries until 2009. Excess mortality rate ratios (EMRR) and 5-year age-standardized relative survival rates were calculated for 15 cancers using age, sex, ethnicity, and calendar-time-specific life tables derived from the cohort at large.
  
  
  
  First Nations diagnosed with cancers of the colon and rectum, lung and bronchus, breast, prostate, oral cavity and pharynx, cervix, ovary, or with non-Hodgkin lymphoma and leukemia all had significantly poorer 5-year survival than their non-Aboriginal peers. For colorectal cancer, a significant disparity was only present between 2001 and 2009 (EMRR: 1.52; 95% CI, 1.28-1.80). For prostate cancer, a significant disparity was only present between 1992 and 2000 (EMRR: 2.76; 95% CI, 1.81-4.21). Adjusting for income and rurality had little impact on the EMRRs.
  
  
  
  Compared with non-Aboriginals, First Nations people had poorer survival for 14 of 15 of the most common cancers, and disparities could not be explained by income and rurality.
  
  
  
  The results of this study can serve as a benchmark for monitoring progress toward narrowing the gap in survival. Cancer Epidemiol Biomarkers Prev; 26(1); 145-51. ©2016 AACR.
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada. diana.withrow@nih.gov.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Diana R
authors.initials: DR
authors.lastname: Withrow
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.|Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pole
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: E Diane
authors.initials: ED
authors.lastname: Nishri
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Tjepkema
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Loraine D
authors.initials: LD
authors.lastname: Marrett
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D019352:Censuses; D015331:Cohort Studies; D016001:Confidence Intervals; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D011159:Population Surveillance; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis