Abstract 135P
Background
Studies have found lower cancer risks and better cancer survival in immigrant populations, findings likely to reflect the ‘healthy migrant effect’.
Methods
We used data in a population-based database to examine clinical presentation, management and mortality in native and immigrants diagnosed with NSCLC in a country with a tax-financed health care system. Analyses were adjusted for comorbidity and other factors that may affect management and outcomes.
Results
We identified 40,075 NSCLC patients, 83.6 % born in Sweden, 7.4 % in Nordic and 9.0 % in non-Nordic countries (Other). Non-Nordic immigrants were to a higher extent male (Sweden 50.2 %, Nordic 53.8 % and Other 66.3 %), smokers (Sweden 42.4 %, Nordic 51.3 % and Other 48.5%), younger (age 0-59 years: Sweden 13.8%, Nordic 15.3 % and Other 29.3 %), had a better performance status (PS 0: Sweden 21.9 %, Nordic 19.5% and Other 26.8 %) and a higher educational level (Post-high school: Sweden 15.6 %, Nordic 9.3 % and Other 22.2 %). No differences were seen regarding comorbidity or stage. PET (Sweden 42.9%, Nordic 41.3 % and Other 50.5 %) and discussions in a multidisciplinary team setting (Sweden 63.4 %, Nordic 64.7 % and Other 70.1 %) were more common in non-Nordic immigrants. No differences were observed in other diagnostics. In stage IA-IIB, surgery was more common in non-Nordic immigrants (Sweden 73.0 %, Nordic 68.8 % and Other 77.8 %), this did not remain following adjustments for age (aOR 0.85 (95% CI 0.71-1.02)). In patients with stage IIIA, treatments were more often offered to non-Nordic immigrants (surgery: Sweden 17.4 %, Nordic 15.1 % and Other 24.4 %; concurrent chemoradiotherapy: Sweden 43.4 %, Nordic 49.7 % and Other 57.2 %). Following adjustments for age, this did not remain for surgery but remained for concurrent chemoradiotherapy (aOR 1.34 (95% CI 1.03-1.74). In patients with stage IIIB-IV, no differences in treatments were observed. Overall and cause-specific survival in stage IA-IIIA was higher in non-Nordic immigrants but did not remain following adjustments. In stage IIIB-IV, there were no differences in survival.
Conclusions
We confirmed a ‘healthy migrant effect’ in non-Nordic immigrants. No differences in management and outcomes were observed between immigrants and native patients following adjustments for age.
Legal entity responsible for the study
Karolinska Institute.
Funding
Swedish Cancer Society.
Disclosure
All authors have declared no conflicts of interest.