Disparities in access to radiation therapy for regions inhabited by a higher proportion of First Nations , Inuit and Métis populations in Canada , and its association with cancer outcomes (original) (raw)
Related papers
Radiotherapy and Oncology, 2020
Background: A high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions. Methods: We used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. We calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center in Canada, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). Results: Median one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 h when considering any transportation mode), and 4111 km (6 h by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4000 h of travel could be saved over a 10-year period for patients with newly diagnosed cancers in Canada, and 7 million km and 10,000 h in Greenland, if radiotherapy was available in Yellowknife, Iqaluit and Nuuk. Conclusions: Geography is an important barrier to accessing radiotherapy for indigenous populations in Canada and Greenland. A significant disparity exists between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight disparities in access to inform radiotherapy service planning.
Geographic Disparities in Cancer Mortality to Incidence Ratios
2014
iv LIST OF TABLES vii LIST OF FIGURES ix CHAPTER 1: INTRODUCTION 1 1.1 Overview 1 1.2 Research Objectives 3 1.3 Structure of the Document 6 CHAPTER 2: CONCEPTUAL DEVELOPMENT 7 2.1 Defining Cancer Vulnerability 7 2.2 Conceptual Development of Vulnerability in Hazards Geography 8 2.3 Conceptual Development in Health Disparities 12 2.4 Place-based Health Vulnerability Model 15 CHAPTER 3: MEASUREMENT OF DRIVERS 18 3.1. Data Sources 20 3.2. Initial Vulnerability Drivers 20 3.3. Cancer Outcome Indicator Mortality to Incidence Ratio (MIR) 43 3.4. Summary and Model Operationalization 45 CHAPTER 4: METHODOLOGY 48
International Journal of General Medicine, 2011
Background: Canadian First Nations, the largest of the Aboriginal groups in Canada, have had lower cancer incidence and mortality rates than non-Aboriginal populations in the past. This pattern is changing with increased life expectancy, a growing population, and a poor social environment that influences risk behaviors, metabolic conditions, and disparities in screening uptake. These factors alone do not fully explain differences in cancer risk between populations, as genetic susceptibility and environmental factors also have significant influence. However, genetics and environment are difficult to modify. This study compared modifiable behavioral risk factors and metabolic-associated conditions for men and women, and cancer screening practices of women, between First Nations living on-reserve and a non-First Nations Manitoba rural population (Canada). Methods: The study used data from the Canadian Community Health Survey and the Manitoba First Nations Regional Longitudinal Health Survey to examine smoking, binge drinking, metabolic conditions, physical activity, fruit/vegetable consumption, and cancer-screening practices. Results: First Nations on-reserve had significantly higher rates of smoking (P , 0.001), binge drinking (P , 0.001), obesity (P , 0.001) and diabetes (P , 0.001), and less leisure-time physical activity (P = 0.029), and consumption of fruits and vegetables (P , 0.001). Sex differences were also apparent. In addition, First Nations women reported significantly less uptake of mammography screening (P , 0.001) but similar rates for cervical cancer screening. Conclusions: Based on the findings of this retrospective study, the future cancer burden is expected to be high in the First Nations on-reserve population. Interventions, utilizing existing and new health and social authorities, and long-term institutional partnerships, are required to combat cancer risk disparities, while governments address economic disparities.
Geographical variation and factors associated with gastric cancer in Manitoba
2021
Objectives We investigated the spatial disparities and factors associated with gastric cancer (GC) Incidence in Manitoba. Methods We combined information from Manitoba Cancer registry and Census data to obtain an agesex adjusted relative risk (IRR) of GC incidence. We geocoded the IRR to the 96 regional health authority districts (RHADs) using the postal code conversion file (PCCF). Bayesian spatial and spatio-temporal Poisson regression models were used for the analysis. Results Adjusting for the effect of socioeconomic score index (SESI), Indigenous, and immigrant population, 25 districts with high overall GC risk were identified. One unit increase in SESI was associated with reduced risk of cardia GC (CGC) by 14% (IRR = 0.859; 95% CI: 0.780-0.947) and the risk of non-cardia GC (NCGC) by approximately 10% (IRR = 0.898; 95% CI: 0.812-0.995); 1% increase in regional Indigenous population proportion reduced the risk of CGC by 1.4% (IRR = 0.986; 95% CI: 0.978-0.994). In the analysis stratified by sex, one unit increase in SESI reduced the risk of CGC among women by 26.2% (IRR = 0.738; 95% CI: 0.618-0.879), and a 1% increase in Indigenous population proportion reduced the risk of CGC among women by 1.9% (IRR = 0.981; 95% CI: 0.966-0.996).
Improving Cancer Incidence Estimates for American Indians inMinnesota
2000
Although less than1%oftheUSpopu- lation identified themselves asAmerican Indian inthe1990USCensus, this group represents morethan 300tribal groups dis- tinct inculture, history, andhealth behav- iors.' Because ofthegreat diversity and small size oftheAmerican Indian popula- tion, accurately estimating thecancer burden andconcomitant cancer prevention andcon- trol needs foraspecific region ortribe isa difficult task. Thetask iscomplicated by 3limitations that plague thedata sources mostoften used toestimate cancer
Cancer Causes & Control, 2017
Background For First Nations (FN) peoples living in British Columbia (BC), little is known regarding cancer in the population. The aim of this study was to explore cancer incidence and survival in the FN population of BC and compare it to the non-FN population. Methods All new cancers diagnosed from 1993 to 2010 were linked to the First Nations Client File (FNCF). Agestandardized incidence rates (ASIR) and rate ratios, and 1and 5-year cause-specific survival estimates and hazard ratios were calculated. Follow-up end date for survival was December 31, 2011 and follow-up time was censored at a maximum of 15 years. Results ASIR of colorectal cancer (male SRR = 1.42, 95% CI 1.25-1.61; female SRR = 1.21, 95% CI 1.06-1.38) and cervical cancer (SRR = 1.84, 95% CI 1.45-2.33) were higher overall in FN residents in BC, compared to non-FN residents. Incidence rates of almost all other cancers were generally similar or lower in FN populations overall and by sex, age, and period categories, compared to non-FN residents. Trends in ASIR over time were similar except for lung (increasing for FN, decreasing for non-FN) and colorectal cancers (increasing for FN, decreasing for non-FN). Conversely, survival rates were generally lower for FN, with differences evident for some cancer sites at 1 year following diagnosis. Conclusion FN people living in BC face unique cancer issues compared to non-FN people. Higher incidence and lower survival associated with certain cancer types require further research to look into the likely multifaceted basis for these findings.
Radiotherapy and Oncology, 2019
Background and purpose: Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada's large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. Materials and methods: We quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010-2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. Results: Median distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14-2095.12). One cluster of worse outcomes (MIR range 0.45-0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40-0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (ß = 0.0001), increased smoking (ß = 0.002), and poorer food security (ß =-0.003) were significantly associated with worse outcomes (OLS R 2 = 0.70, GWR R 2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. Conclusions: A clear north-south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.