Other Immigrant Studies: Cancer and Cancer Registration · PDF fileOther Immigrant Studies:...

Fakultät für Gesundheitswissenschaften School of Public Health – WHO Collaborating Center

Other Immigrant Studies:

Cancer and Cancer Registration

Prof. Oliver Razum

Melina Arnold

EUNAM Meeting

Ferrara, 9 Sep 2011 1


Outline

• Examples of „typical“ projects• MigHealthNet

• MEHO

• MEHO: WP Cancer in Migrants• Migrant health from a lifecourse perspective

• Migration-sensitive Cancer Registration• Survey

• Building migration-sensitive health indicators in

cancer research

• Country Reports2


MigHealthNet (1)

• Supported by the EC's Directorate-General Health and

Consumer Protection (DG SANCO) and the Stavros

Niarchos Foundation (completed in April 2009)

Objectives

• to stimulate the exchange of knowledge and the formation

of networks on migrant and minority health through the

development of interactive databases in each of the

participating countries

• to give professionals, policy makers including health

authorities, researchers, educators and representatives of

migrant and minority groups easy access to a virtual

network of expertise3

See also: http://mighealth.net/

http://mighealth.net/


MigHealthNet (2)

• Implementation of 20 country-specific wikis and one

general wiki

• Participating countries:

• Austria

• Belgium

• Bulgaria

• Czech Republic

• Denmark

• Finland

• France

4

• Germany

• Greece

• Hungary

• Lithuania

• Netherlands

• Norway

• Poland

• Portugal

• Romania

• Sweden

• Switzerland

• Turkey

• United Kingdom

See also: http://mighealth.net/

http://mighealth.net/


MEHO (1)

• Migrant and Ethnic Health Observatory

• Funded under the framework of the Public Health

Programme 2003-2008 of the European Commission

Objectives

• to develop indicators to monitor the health status of

immigrants and ethnic minorities

• to approach the conceptual, methodological, ethical and

practical issue of identifying immigrants and ethnic

minorities in health databases

• to conduct valid comparisons between these groups within

and between European countries and migrant groups 5

See also: http://www.meho.eu.com/

http://www.meho.eu.com/


MEHO (2)

• Five critical health areas/ workpackages

• Mortality

• Cardiovascular Disease and Diabetes

• Cancer

• Infectious Diseases

• Self-perceived health and health care use

• Partners

• Erasmus MC Rotterdam, The Netherlands

• Amsterdam Medical Center/ University of Amsterdam, The Netherlands

• University of Edinburgh, Scotland

• Bielefeld University, Germany

• University of Copenhagen, Denmark

• University of P.J. Safarik Kosice, Slovakia6

See also: http://www.meho.eu.com/

http://www.meho.eu.com/


Cancer in Migrants (I)

• Cancer risks vary

• geographically

• within and between populations

• Assessing the relevance of

• environmental („nurture“) components

• genetic („nature“) components

Lifecourse perspective

Allowing progress in etiology research

Allowing migrant-specific prevention means

7


Cancer in Migrants (II)

• Greater likelihood to develop cancers with a relation to infectious diseases

• Oral cavity, nasopharynx, stomach, liver, gallbladder, cervix uteri, lymphoma

• Decreased risk for cancers associated with a ‚Western‘ lifestyle

• Colorectum, pancreas, lung, breast, ovary, kidney, bladder

8

Arnold, M., O. Razum, and J.W. Coebergh, Cancer risk diversity in non-western migrants to Europe: An overview of the

literature. European journal of cancer (Oxford, England: 1990), 2010. 46(14): p. 2647-59.


Cancer in Migrants (III)

1. Lower all-cancer risk coincide in most studies

irrespective of exact migrant origin

health/epidemiologic transition

2. Susceptibility to certain cancers

life-course perspective can help to identifyimportant exposures during life

3. Cancer risks in migrants converge over time

to be investigated

9

Arnold, M., O. Razum, and J.W. Coebergh, Cancer risk diversity in non-western migrants to Europe: An overview of the

literature. European journal of cancer (Oxford, England: 1990), 2010. 46(14): p. 2647-59.


Migrant health from a lifecourse perspective

10

Spallek J., Zeeb H., Razum O. What do we have to know from migrants‘ past exposures to understand their health status?

A lifecourse approach. Emerg. Themes Epidemiol. 2011. Aug 15;8(1):6.


Migration-sensitive

Cancer Registration

11


Migration-sensitive Cancer Registration

• Questionnaire-based survey among all European

Cancer Registries (n=191)

• Categorization into ‚exemplary‘ and ‚less than

exemplary‘ registries

• Exemplary = Used indicator of ethnicity: country of birth

• Less than exemplary = Used indicators of ethnicity: nationality or race or country of birth of father or country of birth of mother

12


Survey Results (I)

13

191 cancer

registries

contacted

182 registries got an

online questionnaire

25 emails

returned

9 registries got a paper

questionnaire

21 registries

got a paper

version

39 registries

answered

4 registries

with wrong

email address

2 answered

118

registries

reminded

78 cancer registries answered response: 40.8 %

3 answered 34 answered

191 cancer

registries

contacted

182 registries got an

online questionnaire

25 emails

returned

9 registries got a paper

questionnaire

21 registries

got a paper

version

39 registries

answered

4 registries

with wrong

email address

2 answered

118

registries

reminded

78 cancer registries answered response: 40.8 %

3 answered 34 answered

Reeske, A., J. Spallek, and O. Razum, Migrant and Ethnic Health Observatory (MEHO): Migrant-sensitive cancer registration in Europe – Results of a survey

conducted among European cancer registries., in Network Eurolifestyle, Neumann G and Kirch W, Editors. 2008, Thieme Verlag: Stuttgart. p. 11-18.


Survey Results (II)

14

Indicator of migrant background No migrant-

specific data

Country of birth Nationality Race

Total 35 (44.9 %) 6 (7.7 %) 3 (3.8 %) 34 (43.6 %)

Possibility to conduct

migrant-specific analyses

Yes 9 (11.5 %) 0 (0.0 %) 1 (1.3 %) 4 (5.1 %)

Migrant-specific analyses

actually carried out

Routine analyses 1 (1.3 %) 0 (0.0 %) 0 (0.0 %) 0 (0.0 %)

Additional research 6 (7.7 %) 0 (0.0 %) 1 (1.3 %) 2 (2.6 %)

Numerator and

denominator population

available

Yes 2 (2.6 %) 12 (15.4 %) 0 (0.0 %)

Tab. 3.2.1: Main results of the survey conducted among European cancer registries in 2007/08 (n = 78)

Reeske, A., J. Spallek, and O. Razum, Migrant and Ethnic Health Observatory (MEHO): Migrant-sensitive cancer registration in Europe – Results of a survey

conducted among European cancer registries., in Network Eurolifestyle, Neumann G and Kirch W, Editors. 2008, Thieme Verlag: Stuttgart. p. 11-18.


Building migration-sensitive

health indicators in cancer

research

15


Building migration-sensitive health indicators in cancer research (I)

• For indicators we need

• Cases (numerator of an indicator, e.g. risk)

• Background population (denominator)

• Numerator: Cases are collected in cancer registries

Survey about migrant specific data in European cancer registries

• Denominator: Background population

• Registries might have data or information

• Other data sources, e.g. national statistics

• Data linkage

16


Building migration-sensitive health indicators in cancer research (II)

• How to merge numerator and denominator:

• Direct methods

• e.g. record linkage

• Indirect methods

• data linkage (ideally using personal identifiers)

• name-based approaches

• Numerator-only approaches

• e.g. PCIR, relative survival, descriptive analyses

17


Country Reports

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Country Reports: An overview

Country Migrants in

(1) General

population (%),

(2) Largest migrant

groups (origin)*

Indicators

available in

(1) Population

data,

(2) Cancer

registry data

Routine

analyses?

Studies on

cancer in

migrants

Main barriers Current/Future

Potentials

Finland:

Finnish Cancer

Registry

(population-

based, national

level)

(1) 4.4% (foreign

country of birth)

(2) Russia, Estonia

(1) Country of

birth,

Citizenship,

Language

(2) None

• No.

• Using linkage

procedures

• Time consuming

permission procedures

• Costs of additional data

extraction

• Small number of cancer

cases among migrants

• Data linkage

through personal

identity code PID

• Inclusion of

country of origin in

CR data

Germany:

Regional

registries (all 16

federal states

covered in 2011,

completeness

fits international

standards in 14

federal states)

(1) ~20% (migration

background)

(2) Eastern Europe

(resettlers),

South and South

Eastern Europe

(Turkey)

(1) None (Country

of birth in

Mikrocensus

data)

(2) None.

• No.

• Using a name-

based approach

to identify

Turkish cancer

cases

• Setting up a

historical cohort

of resettlers

from the FSU

• Data protection not

officially clarified

• German history

(prosecution of ethnic

minorities)

• Organisation of CRs on

federal state level by

federal state law

lacking data comparability

• Lacking of migrant

indicators in population

data

• Indirect methods

(e.g. name-based

approaches)

• Numerator-only

analyses

• Data linkage

procedures

19


Country Reports: An overview (cont.)

Country Migrants in

(1) General population

(%),

(2) Largest migrant

groups (origin)*

Indicators available

in

(1) Population data,

(2) Cancer registry

data

Routine analyses?

Studies on cancer in

migrants

Main barriers Current/Future

Potentials

Netherlands:

Netherlands

Cancer Registry

(population-

based, national

level)

(1) 19.5% (foreign

background)

(2) Turkey, Morocco,

Western Europe,

Suriname,

Netherlands Antilles,

Indonesia

(1) Country of birth

(2) Country of birth

• No.

• Using linkage

procedures

• No resources for routine

analyses

• Lacking completeness of

country of birth variable

in incidence analyses

• Introduction of citizen

service number (CSN)

will facilitate linkage

Scotland:

Scottish Cancer

Registry

(population-

based, national

level)

(1) 3.8% (foreign country

of birth)

(2) UK, US, Western

Europe, Pakistan,

India, Bangladesh,

China

(1) Ethnic group

(category

classification,

predefined in

Scottish census)

(2) Ethnic group

• No.

• Using name-based

approaches for

migrants from India,

Pakistan and China

• First attempts using

linkage with CHI

• Existing data often

incomplete

• Inconsistent coding of

ethnic groups between

data sources

• Only small ethnic

minority groups

• Linkage procedures

using CHI are

promising and can in

future overcome most

barriers

Sweden:

Swedish

Cancer Register

(population-

based, national

level)

(1) 13.8% (foreign

country of birth)

(2) Europe (mostly

Scandinavia), Iraq,

Iran, Former

Yugoslavia, Poland

(1) Country of birth,

foreign

background

(2) None.

• Yes.

• Using the Health

and Migration

Cohort

• Using the Family-

Cancer Database

• Lack of information on

ethnicity (variation within

the same country of

origin)

• Technical solutions are

still under development

• PIN facilitates linkage

of registers and

enables all kinds of

analyses (incidence,

mortality, survival) and

covariates (e.g. SES)


Conclusion

• Major barriers identified

- Incompleteness of nationality data in the registries

- Naturalized immigrants

- Background population/denominator must be defined in the same way as numerator

- Heterogeneity of migrant groups and origins

- Heterogeneity of applied definitions and measures of association

- 100% overlap of catchment area of registry and statistical region for background population is needed

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Projects

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Suggested readings

23

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