Ethnic differences in the characteristics of patients with newly diagnosed lung cancer in the Te Manawa Taki region of New Zealand.

Māori cancer stage ethnic differences inequity lung cancer

Journal

Internal medicine journal
ISSN: 1445-5994
Titre abrégé: Intern Med J
Pays: Australia
ID NLM: 101092952

Informations de publication

Date de publication:
16 Aug 2023
Historique:
received: 16 12 2022
accepted: 19 07 2023
medline: 16 8 2023
pubmed: 16 8 2023
entrez: 16 8 2023
Statut: aheadofprint

Résumé

Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics. To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori. Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers. The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand.

Sections du résumé

BACKGROUND BACKGROUND
Māori have three times the mortality from lung cancer compared with non-Māori. The Te Manawa Taki region has a population of 900 000, of whom 30% are Māori. We have little understanding of the factors associated with developing and diagnosing lung cancer and ethnic differences in these characteristics.
AIMS OBJECTIVE
To explore the differences in the incidence and characteristics of patients with newly diagnosed lung cancer between Māori and non-Māori.
METHODS METHODS
Patients were identified from the regional register. Incidence rates were calculated based on population data from the 2013 and 2018 censuses. The patient and tumour characteristics of Māori and non-Māori were compared. The analysis used Χ
RESULTS RESULTS
A total of 4933 patients were included, with 1575 Māori and 3358 non-Māori. The age-standardised incidence of Māori (236 per 100 000) was 3.3 times higher than that of non-Māori. Māori were 1.3 times more likely to have an advanced stage of disease and 1.97 times more likely to have small cell lung cancer. Māori were more likely to have comorbidities, chronic obstructive pulmonary disease, cardiovascular disease and diabetes. They also had higher levels of social deprivation and tended to be younger, female and current smokers.
CONCLUSIONS CONCLUSIONS
The findings point to the need to address barriers to early diagnosis and the need for system change including the need to introduce a lung cancer screening focussing on Māori. There is also the need for preventive programmes to address comorbidities that impact lung cancer outcomes as well as a continued emphasis on creating a smoke-free New Zealand.

Identifiants

pubmed: 37584463
doi: 10.1111/imj.16202
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Health Research Council of New Zealand
ID : 21/990

Informations de copyright

© 2023 Royal Australasian College of Physicians.

Références

Robson B, Cormack D, Purdie G. Unequal Impact II: Māori and Non-Māori Cancer Statistics by Deprivation and Rural-Urban Status 2002-2006: Te Rōpū Rangahu Hauora a Eru Pōmare. Wellington: University of Otago; 2010.
Reid P, Cormack D, Paine S-J. Colonial histories, racism and health-the experience of Māori and indigenous peoples. Public Health 2019; 172: 119-24.
HQSC. HQSC Atlas of Healthcare Variation - Lung cancer [cited 2022 Dec 16]. Available from URL: https://www.hqsc.govt.nz/assets/resources/Health-Quality-Evaluation/Atlas/LungCancerSF/atlas.html
Ministry of Health. Ngā mana hauora tūtohu: health status indicators 2013 [cited 2022 Dec 16]. Available from URL: https://www.health.govt.nz/our-work/populations/maori-health/tatau-kahukura-maori-health-statistics/nga-mana-hauora-tutohu-health-status-indicators/cancer.
Ministry of Health. Cancer patient survival 1994-2011 [cited 2022 Dec 16]. Available from URL: https://www.health.govt.nz/system/files/documents/publications/cancer-patient-survival-1994-2011-apr15-v2.pdf
Hill S, Sarfati D, Robson B, Blakely T. Indigenous inequalities in cancer: what role for health care? ANZ J Surg 2013; 83: 36-41.
Lawrenson R, Lao C, Brown L, Wong J, Middleton K, Firth M et al. Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry. NZ Med J 2018; 131: 13-23.
Glasheen WP, Cordier T, Gumpina R, Haugh G, Davis J, Renda A. Charlson comorbidity index: ICD-9 update and ICD-10 translation. Am Health Drug Benefits 2019; 12: 188-97.
Dayen C, Debieuvre D, Molinier O, Raffy O, Paganin F, Virally J et al. New insights into stage and prognosis in small cell lung cancer: an analysis of 968 cases. J Thorac Dis 2017; 9: 5101-11.
Kim CH, Lee YCA, Hung RJ, McNallan SR, Cote ML, Lim WY et al. Exposure to secondhand tobacco smoke and lung cancer by histological type: a pooled analysis of the International Lung Cancer Consortium (ILCCO). Int J Cancer 2014; 135: 1918-30.
Toh C-K, Gao F, Lim W-T, Leong S-S, Fong K-W, Yap S-P et al. Differences between small-cell lung cancer and non-small-cell lung cancer among tobacco smokers. Lung Cancer 2007; 56: 161-6.
McLeod M, Sandiford P, Kvizhinadze G, Bartholomew K, Crengle S. Impact of low-dose CT screening for lung cancer on ethnic health inequities in New Zealand: a cost-effectiveness analysis. BMJ Open 2020; 10: e037145.
Manners D, Dawkins P, Pascoe D, Crengle S, Bartholomew K, Leong TL. Lung cancer screening in Australia and New Zealand: the evidence and the challenge. Intern Med J 2021; 51: 436-41.
World Cancer Research Fund International. Lung cancer statistics [cited 2022 Dec 16]. Available from URL: https://www.wcrf.org/cancer-trends/lung-cancer-statistics/.
National Cancer Institute. Cancer Statistics [cited 2022 Dec 16]. Available from URL: https://seer.cancer.gov/statistics-network/
Stevens W, Murray M. Barriers to the early diagnosis of lung cancer and recommended best practice solutions, with particular reference to Maori and Pacific peoples. Aust Epidemiol 2010; 17: 11-15.
Walker T, Signal L, Russell M, Smiler K, Tuhiwai-Ruru R. The road we travel: Māori experience of cancer. New Zealand Med J. 2008; 121: 27-35.
Lawrenson R, Cassim S, Kidd J, Rolleston A, Hokowhitu B, Chepulis LM et al. Ha ora: improving access to early diagnosis of lung cancer for Maori and rural communities. Understanding patient experiences in General Practice (Report). 2021.
Sood J-D, Wong C, Bevan R, Veale A, Sivakumaran P. Delays in the assessment and management of primary lung cancers in South Auckland. New Zealand Med J 2009; 122: 42-50.
Stevens W, Stevens G, Kolbe J, Cox B. Comparison of New Zealand Cancer Registry data with an independent lung cancer audit. New Zealand Med J 2008; 121: 29-41.
Cassim S, Kidd J, Rolleston A, Keenan R, Aitken D, Firth M et al. Hā Ora: barriers and enablers to early diagnosis of lung cancer in primary healthcare for Māori communities. Eur J Cancer Care 2021; 30: e13380.
Walter F, Webster A, Scott S, Emery J. The Andersen Model of Total Patient Delay: a systematic review of its application in cancer diagnosis. J Health Serv Res Policy 2012; 17: 110-8.
Cormack D, Robson B, Purdie G, Ratima M, Brown R. Access to cancer services for Maori: a report prepared for the Ministry of Health, Wellington School of Medicine and Health Sciences, 2005. 2008.
Espiner E, Paine S-J, Weston M, Curtis E. Barriers and facilitators for Māori in accessing hospital services in Aotearoa New Zealand. N Z Med J 2021; 134: 47-5.
Emery JD, Murray SR, Walter FM, Martin A, Goodall S, Mazza D et al. The chest Australia trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer. Thorax 2019; 74: 362-70.
Stevens W, Stevens G, Kolbe J. Recommendations to expedite the diagnosis of lung cancer. Final report of the HRC_DHBNZ funded project:‘Identification of barriers to the early diagnosis of people with lung cancer and description of best practice solutions’(Northern Cancer Network); 2012.
Brabyn L, Barnett AR. Population need and geographical access to general practitioners in rural New Zealand; 2004.
Field J, Duffy S, Baldwin D, Whynes D, Devaraj A, Brain K et al. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2016; 71: 161-70.
Lam S, Tammemagi M. Contemporary issues in the implementation of lung cancer screening. Eur Respir Rev 2021; 30: 200288.
Yang D, Liu Y, Bai C, Wang X, Powell CA. Epidemiology of lung cancer and lung cancer screening programs in China and the United States. Cancer Lett 2020; 468: 82-7.
Becker-Blease JR. Governance and innovation. Finance 2011; 17: 947-58.
Van Gestel YR, Hoeks SE, Sin DD, Hüzeir V, Stam H, Mertens FW et al. COPD and cancer mortality: the influence of statins. Thorax 2009; 64: 963-7.
Wakelee HA, Chang ET, Gomez SL, Keegan TH, Feskanich D, Clarke CA et al. Lung cancer incidence in never-smokers. J Clin Oncol Off J Am Soc Clin Oncol 2007; 25: 472-8.

Auteurs

Ha Nguyen (H)

Medical Research Centre, University of Waikato, Hamilton, New Zealand.

Chunhuan Lao (C)

Medical Research Centre, University of Waikato, Hamilton, New Zealand.

Rawiri Keenan (R)

Medical Research Centre, University of Waikato, Hamilton, New Zealand.

George Laking (G)

Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand.

Mark Elwood (M)

Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Mark McKeage (M)

Faculty of Medical and Health Sciences, University of Auckland and Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand.

Janice Wong (J)

Te Whatu Ora Health New Zealand, Hamilton, New Zealand.

Denise Aitken (D)

Te Whatu Ora Health New Zealand, Rotorua, New Zealand.

Lynne Chepulis (L)

Medical Research Centre, University of Waikato, Hamilton, New Zealand.

Ross Lawrenson (R)

Medical Research Centre, University of Waikato, Hamilton, New Zealand.
Te Whatu Ora Health New Zealand, Hamilton, New Zealand.

Classifications MeSH