Trends in cancer mortality among migrants in England and Wales, 1979–2003
Introduction
Ethnic specific trends in cancer mortality provide aetiological clues about both how environmental exposure affects susceptibility to cancers and how successfully they are managed. However, remarkably little cancer incidence or survival data for ethnic minority groups exist in the United Kingdom (UK). Additionally, annual death rates by ethnicity are not available in the UK. Ethnic origin is not recorded at death registration in England and Wales and analysis relies on decennial rates based on information by country of birth from the census and from deaths registered around the time of the census. Previous studies have focused on mortality from main cancers and, compared with the England and Wales national average, have shown relatively high all cancer mortality for Scottish and Irish migrants and low mortality for South Asian and Caribbean migrants.1, 2 Mortality trends have never been explored. This paper examines trends for a range of cancers using data for 1979–1983, 1989–1993 and 1999–2003.
Most incidence research relates to South Asian migrants and findings suggest convergence in cancer risk towards that of the host population.3, 4 South Asian women appear to have both lower incidence and better survival from breast cancer compared with all other women.5 Evidence is patchier for other migrant groups. While data from the England and Wales Longitudinal Study suggest that incidence of all combined cancers is lower in Caribbeans compared with the national average,6 a later factory-based cohort in Birmingham estimated similar incidence rates for both Caribbean and White European men.7 Incidence of prostate cancer is thought to be more than twice as high in Caribbean men than in other men.8 Higher incidence of smoking-related cancers has been reported for Scottish and Irish migrants.6
Section snippets
Methods
The Office for National Statistics provided anonymised death records for 1979–1983, 1989–1993 and 1999–2003, and tabulated population data from the 1981, 1991 and 2001 censuses for England and Wales. Deaths and populations-at-risk were derived by country of birth and 5-year age groups. Due to the small number of deaths at younger ages, and potentially poor quality denominator data at older ages for some groups, analyses were restricted to those aged 30–69 years. Countries of birth were included
Results
For women born in Scotland, Northern Ireland or the Republic of Ireland, lung cancer was the highest ranking cancer cause of death in all periods followed by breast cancer in the latter two periods. This ranking was reversed in most of the other female migrant groups. For men lung cancer was the most common cancer cause of death in all groups except in the other Caribbean group – where prostate cancer ranked highest in the final period. The second most common male cancer tended to be stomach or
Discussion
Trends in cancer mortality reflect changes in risk behaviours (for example, smoking or diet), new screening practices and the development and use of new and more effective treatments. Large mortality declines for common cancers in the 1990s among those born in England and Wales, including cancers with high case fatality such as lung and pancreatic cancers, correspond with trends in other Western European countries.9, 10, 11 Compared with those born in England and Wales, smaller or similarly
Conclusion
A pattern of declines in the death rates for the major cancers was observed across many countries of birth groups, more so in the second than the first decade, but smaller or non-significant shifts compared with those for England and Wales led to little or no improvement in the mortality differentials between migrants and those born in England and Wales. The majority of cancer deaths among migrants are attributed to commonly occurring cancers and there is no reason to believe that there is
Conflict of interest statement
None declared.
Acknowledgements
We are grateful to Mr Allan Baker at the Office for National Statistics for supplying the mortality data and addressing our queries, and Ms Kate Forbes for preparing the tables and graphs.
SH produced the first draft of the manuscript, SH and MR initiated the project, MR and AT conducted the analyses and all authors redrafted the paper and are the guarantors of the paper. SH and AT are funded by the Medical Research Council, United Kingdom (WBS U.1300.00.003.00008.01). MR is funded by a
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