TITLE: Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths.
AUTHOR: Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S
AFFILIATION: Division of Cardiology, Hamilton Civic Hospitals Research Centre, McMaster University, Ont., Canada.
SOURCE: CMAJ 1999 Jul 27;161(2):132-8
ABSTRACT: BACKGROUND: Cardiovascular disease and cancer are important health problems worldwide, yet our knowledge of these conditions is derived principally from populations of European descent. To investigate ethnic variations in major causes of death in Canada, the authors examined total and cause-specific mortality among European, south Asian, and Chinese Canadians. METHODS: Canadians of European, south Asian and Chinese origin were identified in the Canadian Mortality Database by last name and country of birth and in the population census by self-reported ethnicity. Age-standardized death rates by cause, per 100,000 population, were calculated for ages 35 to 74 years from 1979 to 1993 and in 5-year intervals grouped around census years (1979/83, 1984/88 and 1989/93). RESULTS: Rates of death from ischemic heart disease were highest among Canadians of south Asian origin (men 320.2, women 144.5) and European origin (men 319.6, women 109.9) and were markedly lower among Canadians of Chinese origin (men 107.0, women 40.0); the rates declined significantly in all 3 groups over the study period. Rates of death from cerebrovascular disease were relatively low and showed less ethnic variation (Canadian men of European, south Asian and Chinese origin 49.5, 47.0 and 45.8 respectively; Canadian women of European, south Asian and Chinese origin 34.8, 39.0 and 42.2 respectively) and declined similarly in all groups over time. Rates of death from cancer were highest among Canadians of European origin (men 343.6, women 236.2), intermediate among those of Chinese origin (men 258.1, women 161.6) and lowest among those of south Asian origin (men 122.3, women 131.3). Over time, cancer mortality increased in Canadians of European origin but remained constant or declined in those of south Asian and Chinese origin. INTERPRETATION: Substantial differences exist in rates of death from ischemic heart disease and cancer among European, south Asian and Chinese Canadians.
TITLE: Breast cancer detection practices of south Asian women: knowledge, attitudes, and beliefs.
AUTHOR: Choudhry UK, Srivastava R, Fitch MI
AFFILIATION: Seneca College.
SOURCE: Oncol Nurs Forum 1998 Nov-Dec;25(10):1693-701
ABSTRACT: PURPOSE/OBJECTIVES: To explore knowledge, attitudes, beliefs, and practices regarding breast cancer detection practices among South Asian women. DESIGN: Descriptive exploratory design. SETTING: Toronto, Ontario, Canada. SAMPLE: 57 South Asian women, age 40 and over, who are first generation immigrants from India and Pakistan and speak one of the four languages identified for the study--Hindi, Punjabi, Gujarati, or Urdu. METHODS: An interview guide was designed specifically for this study. It contained questions regarding knowledge, attitudes, beliefs, and practices about breast self-examination (BSE), clinical breast examination (CBE), and mammogram. In addition, questions assessing the variables of the Health Belief Model and health motivations also were included. The data were obtained during face-to-face interviews in the primary language of the participating woman. The interviews were transcribed and translated into English. FINDINGS: 12% of the participants practiced BSE monthly, 49% had undergone at least one CBE during their lives, and 47% had never had a mammogram. The majority (54%) said they did not know very much about breast cancer. While 21% of the women said detecting cancer early was important, only 5% reported that cancer could be cured. Age, education, or mother tongue showed no statistically significant relationship with the breast health practice scores. However, proficiency with the English language (p = 0.009) and number of years in Canada (p = 0.009) had a significant relationship with the breast health practice scores. The significant explanatory factor for the variable breast health practices was a cue to action (p = 0.009). CONCLUSIONS: South Asian women with minimal knowledge of breast cancer did not engage in breast cancer detection practices. IMPLICATIONS FOR NURSING PRACTICE: This segment of the population of immigrant women needs to be better informed about breast cancer and the benefits of breast cancer detection practices.
TITLE: Cancer incidence in Asian migrants to New South Wales, Australia.
AUTHOR: Grulich AE, McCredie M, Coates M
AFFILIATION: Cancer Epidemiology Research Unit, NSW Cancer Council, Australia.
SOURCE: Br J Cancer 1995 Feb;71(2):400-8
ABSTRACT: Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrant's adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation.
TITLE: The use of tobacco and betel quid ('pan') among Bangladeshi women in West Yorkshire.
AUTHOR: Summers RM, Williams SA, Curzon ME
AFFILIATION: Division of Child Dental Health, University of Leeds, UK.
SOURCE: Community Dent Health 1994 Mar;11(1):12-6
ABSTRACT: The high prevalence of oral cancer in South Asia has been linked to tobacco use particularly in conjunction with chewing betel quid or 'pan'. However, it is not known whether and to what extent these habits are practised by Asian people in the United Kingdom. Home based interviews using semi-structured questionnaires were undertaken among 296 first generation Bangladeshi women resident in inner-city Leeds and Bradford, West Yorkshire. 'Pan' was reportedly chewed by 282 (95 per cent) of the women, of whom 174 (62 per cent) added tobacco in leaf form, and 75 (27 per cent) as a component of zarda. Those who consumed more 'pans' daily were significantly older, less literate, had a lower educational attainment, and were more likely to believe that chewing betel quid was beneficial. Cigarette smoking was practised by 9 per cent, this group being older and having lived in the UK longer. Burnt tobacco leaves were used as an oral hygiene aid by 20 per cent. Over half (58 per cent) of the sample had never visited a dentist, the majority deeming it unnecessary. The use of tobacco and 'pan' imply an increased risk for oral cancer and precancer. Since 'pan' chewing is a traditional custom, health promotion within these communities would require a sensitive approach. Health personnel likely to be consulted by Asian groups who chew 'pan' should be aware of the danger to oral health posed by this practice.
TITLE: Cervical cancer: trends in incidence and mortality in Singapore 1968 to 1987.
AUTHOR: Seow A, Chia KS, Lee HP
AFFILIATION: Department of Community, Occupational and Family Medicine, National University of Singapore.
SOURCE: Ann Acad Med Singapore 1992 May;21(3):328-33
ABSTRACT: Analysis of data collected by the population-based Singapore Cancer Registry reveals that the age-standardised incidence of cervical cancer has decreased from 18.2 per 100,000 females in 1968-72 to 16.2 per 100,000 in 1983-87, and its ranking among the most common female cancers has fallen from second to fourth place behind cancers of the breast, colon/rectum and lung. Mortality from the disease has also shown a corresponding fall from 7.3 per 100,000 to 5.5 per 100,000 women over the same period. Cervical cancer incidence rates are in general highest among Indian women, intermediate in Chinese and lowest in Malays. Age-specific incidence curves over time show a marked fall in rates in women over 50 years of age, whereas younger women (35-44 years old) show a small increase. A similar increase in rates has been observed in various other countries. Internationally, Singapore's incidence rate falls between the highs of South America and parts of Asia, and the lower rates of North America and Europe. The decrease in rates is comparable with the overall global trend, but falls short of that achieved by countries with systematic cytological screening programmes.
TITLE: Epidemiology of digestive tract cancers in India. V. Large and small bowel.
AUTHOR: Mohandas KM, Desai DC
AFFILIATION: Division of Digestive Diseases and Nutrition, Tata Memorial Hospital, Mumbai.
SOURCE: Indian J Gastroenterol 1999 Jul-Sep;18(3):118-21
ABSTRACT: The large bowel is a leading site for cancers in developed countries whereas small bowel cancers are rare worldwide. The incidence rates of both large and small bowel cancer are low in India, and rectal cancer is more common than colon cancer. The incidence rates of colon cancer in eight population registries vary from 3.7 to 0.7/100,000 among men and 3 to 0.4/100,000 among women. For rectal cancer the incidence rates range from 5.5 to 1.6/100,000 among men and 2.8 to 0/100,000 among women. One intriguing observation is the occurrence of rectal cancer in young Indians. Rural incidence rates for large bowel cancers in India are approximately half of urban rates. Based on data from eight registries, we estimate that, in the year 2001, the incidence of large bowel cancer in India will be 18,427 in men and 13,092 in women. Immigrant studies reveal an increase in incidence as compared to the rates in native counterparts. Reliable time trends for India are available only from the Bombay registry. Significant increase in the incidence of colon cancer has been reported for both men and women over two decades, but the rates of rectal cancer are steady. The low incidence of large bowel cancers in Indians can be attributed to high intake of starch and the presence of natural antioxidants such as curcumin in Indian cooking. The role of hereditary factors has been evaluated in a few studies. Some studies have reported the occurrence of both FAP and HNPCC in India. There are no Indian studies on large bowel cancer prevention. The prevalence of adenomas is rare in elderly Indians undergoing colonoscopy, even in those with large bowel cancers. Small bowel cancers are extremely rare in India and no analytical studies have been published. Hospital-based data suggest that lymphomas of small bowel are more common than carcinomas. In conclusion, the incidence of large and small bowel adenomas and cancers is low in Indians. Increase in the incidence of large bowel cancers in immigrants and urban Indians compared to rural populations supports a role for environmental risk factors including diet. High rates of rectal cancers in young Indians could suggest a different etiopathogenesis, which is neither inherited nor traditional diet-related.
TITLE: Epidemiology of digestive tract cancers in India IV. Gall bladder and pancreas.
AUTHOR: Dhir V, Mohandas KM
AFFILIATION: Division of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai.
SOURCE: Indian J Gastroenterol 1999 Jan-Mar;18(1):24-8
ABSTRACT: Pancreatic cancer is a leading cause of cancer-related deaths in developed countries. Gall bladder cancer is very common in South American countries, around the Mediterranean and in Japan. A majority of patients with these cancers receive only palliative therapy in spite of recent advances in investigation and surgery. Their poor prognosis and increasing incidence in India necessitate a better epidemiologic approach towards their control. This review is based on epidemiological data, publications and abstracts from India. Population-based data reveal that the incidence of gall bladder cancer is very high in northern Indian cities (5-7 per 100,000 women) and low (0-0.7 per 100,000 women) in southern India. The distribution suggests a high-incidence region comprising Uttar Pradesh, Bihar, Orissa, West Bengal and Assam. The cancer is twice more common in women and is the leading cancer among digestive cancers in women in the northern Indian cities of Delhi and Bhopal. There are few analytical data to hypothesize why this geographical predisposition. The high incidence is also observed in north Indian immigrants to the United Kingdom. The incidence of pancreatic cancer is low (0.5-2.4 per 100,000 men and 0.2-1.8 per 100,000 women) in most parts of India. Somewhat higher rates are seen in the male urban populations of western and northern India. Studies from Kerala support an association between tropical pancreatitis and pancreatic cancer. Time trends reveal an increase in the incidence of gall bladder and pancreas cancers; the increase in the former is alarming. We estimate that the approximate annual cancer burden of India in 2001 would include 17,730 cases of gallbladder cancer and 14,230 of pancreatic cancer. Multi-center studies are needed to identify potentially preventable risk factors associated with gall bladder and pancreatic cancer in India.
TITLE: Expression of cell surface glycoprotein CD44 and integrins in breast cancers among Indian women.
AUTHOR: Menon MM, Thakur R, Simha MR, Kurkure AP, Kenkare UW, Doctor VM
AFFILIATION: Department of Immunology, Breach Candy Medical Research Centre, Bombay, India.
SOURCE: Tumori 1998 Sep-Oct;84(5):589-94
ABSTRACT: Parsis, the sole surviving group of followers of Zoroaster who are settled in Bombay, have a fourfold higher incidence of breast cancer than the general population of Greater Bombay. CD44 expression was studied by immunohistochemistry in breast cancers of 50 non-Parsi and 35 Parsi women, 10 normal breast tissues, 10 proliferative lesions and 49 tissues adjoining a tumor mass. Alpha2 and beta1 integrins could be studied in only 42 malignant cases and five normal tissues. The immunohistochemistry results were correlated with other parameters including tumor grade and size, estrogen and progesterone receptor status, lymph node involvement and mitotic index. CD44 was not expressed in normal areas. Benign areas and tissues adjacent to tumor masses showed increased staining. Both Parsi and non-Parsi women showed significantly high CD44 expression. All Parsi ILCs were strongly positive for CD44. In both groups ER negativity was associated with strong CD44 positivity, while mitotic counts correlated with decreased CD44 expression in Parsis but not in non-Parsis. Alpha2 and beta1 integrins were strongly expressed on the basolateral surface of normal epithelium. However, they were downregulated in tumors. In general breast tumor tissues from Parsi and non-Parsi patients did not differ significantly with respect to most parameters. However, among Parsis lymph node involvement and CD44 correlated weakly whereas the mitotic index was inversely correlated with CD44. The reverse was true for non-Parsis. The deviation from the general pattern needs further study based on a large number of samples and appropriate use of splice variants.
TITLE: Descriptive epidemiology of thyroid cancer in greater Bombay.
AUTHOR: Yeole BB
AFFILIATION: Bombay Cancer Registry, Indian Cancer Society, Parel, Bombay, India.
SOURCE: Indian J Cancer 1998 Jun;35(2):57-64
ABSTRACT: In this paper an attempt has been made to present a descriptive epidemiology of thyroid cancer in Bombay, and it is discussed in relation to age, demographic and socio economic composition of the population, using the most recent five year date. Time trend analysis of this cancer by sex has also been discussed using the last 30 years data. When international incidence of thyroid cancer was ranked in descending order for various countries, the incidence recorded for Bombay was found to be at the lowest level in both the sexes. Thyroid cancer is about three times more frequent among women than men, but this relative excess varies with the histologic type and age. As in the case of the majority of cancers, the incidence curve for thyroid cancer rises with age. However in men, the increase continues consistently with advancing age, while in women it begins to level off after the age 30, leading to an almost equal sex ratio in old age. In Bombay the incidence of thyroid cancer in men was found to be the highest in Muslims and in Christian women. No association was observed between thyroid cancer and education level attained by these patients. The four main histologic types of thyroid cancers i.e. papillary, follicular, anaplastic and medullary are also observed in Bombay. It has been noted that there is an increasing trend in the age-adjusted incidence rate for thyroid cancer in both the sexes in Bombay in the period under review 1964 to 1993. But the increase in incidence was found to be statistically significant only in males.
TITLE: Serum lipid profile and its relationship with host immunity in carcinomas of the breast and uterine cervix.
AUTHOR: Ray A, Sharma BK, Bahadur AK, Pasha ST, Bhadola P, Murthy NS
AFFILIATION: Institute of Cytology and Preventive Oncology (ICMR), National Institute of Communicable Diseases, New Delhi, India.
SOURCE: Tumori 1997 Nov-Dec;83(6):943-7
ABSTRACT: Carcinomas of the uterine cervix and breast, which have a different etiopathogenesis, are the most common malignancies among Indian women. Between these two cancers a comparative study was undertaken in which serum lipids were assessed along with host immunity. Thirty randomly selected cases each of breast and cervical carcinoma, and 20 matched healthy control women were studied by means of standard procedures. Significantly higher (P < 0.001) mean levels of triglycerides (x = 192.1 mg/dl, SD +/- 113.5) and total cholesterol (x = 212.9 mg/dl, SD +/- 49.78) were observed in breast cancer as compared to controls or cervical cancer patients. Patients with cervical cancer had low mean values of all lipid fractions. Women with the above malignancies also showed a significantly decreased CD3+ and CD4+ population (P < 0.001), while there was a significant increase in CD8+ cells (P < 0.005) compared to normal controls. Interestingly, a significant relationship (P < 0.05) was observed between CD8+ cells and LDL-cholesterol among the cancer patients (r = 0.3652 and r = 0.4298 for carcinomas of breast and cervix, respectively.
TITLE: Use of betel quid and cigarettes among Bangladeshi patients in an inner-city practice: prevalence and knowledge of health effects.
AUTHOR: Ahmed S, Rahman A, Hull S
AFFILIATION: Steels Lane Health Centre, London.
SOURCE: Br J Gen Pract 1997 Jul;47(420):431-4
ABSTRACT: BACKGROUND: Betel quid chewing, often combined with tobacco chewing, is a common habit in the Indian subcontinent. It is associated with the development of malignancy of the oral mucosa and foregut. Among Asian communities in the United Kingdom (UK), Bangladeshis are particularly likely to retain this habit. AIM: To investigate the prevalence of betel quid chewing, smoking, and knowledge of health hazards associated with these habits among the Bangladeshi population in an east London general practice. METHOD: A bilingual postal questionnaire to all 306 adults (25 years and over) identified as being of Bangladeshi origin within one practice in east London. RESULTS: The questionnaire response rate was 46%. The prevalence of betel quid chewing was over 80% with no sex difference. Men were more likely to smoke tobacco than women (men = 57%, women = 11%, X2 = 33.3, P < 0.001), but over half the women added tobacco to their quid for chewing. Whereas over 80% of both male and female respondents identified the health risk of smoking, only one third identified oral cancer as a risk. In all, 25% of respondents started chewing in the UK. CONCLUSIONS: The low response rate is discussed. The findings indicate that the majority of Bangladeshi respondents are unaware of the health risks of a common social habit, although well informed about smoking risks. A government health warning should be introduced for betel quid sold in the UK.
TITLE: A case-control investigation on cancer of the ovary in Bangalore, India.
AUTHOR: Nandakumar A, Anantha N, Dhar M, Ahuja V, Kumar R, Reddy S, Venugopal T, Rajanna, Vinutha AT, Srinivas
AFFILIATION: Coordinating Unit, National Cancer Registry Programme of India (Indian Council of Medical Research), Bangalore, India.
SOURCE: Int J Cancer 1995 Nov 3;63(3):361-5
ABSTRACT: Cancer of the ovary is the sixth leading cancer among females in Bangalore, and is a leading site of cancer in other population-based cancer registries in India. A case-control investigation was conducted utilizing the data from the population-based cancer registry in Bangalore. In addition to the core patient information, certain other details pertaining to consumption of tobacco, reproductive and obstetric factors and those related to the practice of family planning, including the method adopted, were available with the registry, for the period 1982-1985. Identical information was also available for patients residing in the registry area who did not have cancer. Ninety-seven cases of ovarian cancer in ever-married women were age-matched with 194 controls from the same area who showed no evidence of cancer. The risk of ovarian cancer was not influenced by tobacco habits, alcohol consumption, diet or the various reproductive factors. However, tubectomy as a method of family planning appeared to reduce the risk of development of ovarian cancer. This reduction in risk was not influenced by parity or age of the woman at the time of birth of the first child.
TITLE: Cancer mortality in Indian and British ethnic immigrants from the Indian subcontinent to England and Wales.
AUTHOR: Swerdlow AJ, Marmot MG, Grulich AE, Head J
AFFILIATION: Epidemiological Monitoring Unit, London School of Hygiene & Tropical Medicine, UK.
SOURCE: Br J Cancer 1995 Nov;72(5):1312-9
ABSTRACT: Risk of cancer mortality from 1973 to 1985 in persons born in the Indian subcontinent who migrated to England and Wales was analysed by ethnicity, and compared with cancer mortality in the England and Wales native population, using data from England and Wales death certificates. There were substantial highly significant raised risks in Indian ethnic migrants for cancers of the mouth and pharynx, gall bladder, and liver in each sex, larynx and thyroid in males, and oesophagus in females. There were also substantial raised risks in these migrants of each sex for non-Hodgkin's lymphoma and myeloma. For the mouth and pharynx, and liver in each sex, and gall bladder in females, there were also raised risks of lesser magnitude in British ethnic migrants. For colon and rectal cancer and cutaneous melanoma in each sex, ovarian cancer in women and bladder cancer in men, there were appreciable significantly reduced risks in the Indian ethnic migrants not shared by those of British ethnicity. Appreciable raised risks in British ethnic migrants not shared by those of Indian ethnicity occurred for nasopharyngeal cancer in males, soft tissue malignancy in both sexes and non-melanoma skin cancer in males. In migrants of both ethnicities there were appreciable significantly raised risks in each sex for leukaemia and decreased risks in each sex for gastric cancer, for lung cancer except in females of British ethnicity and in males for testicular cancer. The results suggest the need for public health measures to combat the high risks of oral and pharyngeal cancers and liver cancer in the Indian ethnic immigrant population of England and Wales, by prevention of betel quid chewing and hepatitis transmission respectively. The data also imply that early exposures or early acquired behaviours in India, or exposures during migration, may increase the risk of leukaemia and reduce the risks of gastric and testicular cancers in the migrants irrespective of their ethnicity. Aetiological studies would be worthwhile to investigate the reasons for the sizeable decreased risk of colon and rectal cancer and increased risk of gall bladder cancer in each sex and the increased risk of thyroid and laryngeal cancer in males and oesophageal cancer in females of Indian ethnicity but not of British ethnicity who have migrated from the Indian subcontinent.
TITLE: Age at marriage and cervical cancer incidence.
AUTHOR: Prabhakar AK, Menon GR
AFFILIATION: Indian Council of Medical Research, Ansari Nagar, New Delhi, India.
SOURCE: Indian J Cancer 1995 Jun;32(2):63-8
ABSTRACT: Cancer of the uterine cervix is the commonest cancer among Indian women accounting for 1/5 of the total cancer incidence. It is the estimated that by the turn of century 139,000 women in India would be developing cervical cancer. Age at marriage has been recognised as a major risk factor associated with cervical cancer. Over the past 8 decades there has been a rise in age at marriage varying from 14 years in 1901 to 18 years in 1981. Consequently the proportion of women married in the age group 15-19 years has fallen from 88% in 1941 to 45% in 1981. The present paper has attempted to study the effect of change in proportion married below 17 years on cervical cancer incidence for the year 1985 in India. The proportion of married women in the age group 15-19 years was constant around 88% from 1901-41 and from 1951 onwards the reduction in the proportion married has been observed. During the last 35 years, after the start of reduction in the proportion married in the age group (15-19) years, a reduction of 2097 cervical cancer cases or 6.3 percent reduction in the incidence of invasive cervical cancer is observed. It may be postulated that it will take a long time to expect a significant reduction in the incidence of cervical cancer if the primary prevention of rising the age at marriage above 18 years is adopted as a strategy for control of cervical cancer.
TITLE: Incidence, mortality and survival in cancer of the cervix in Bangalore, India.
AUTHOR: Nandakumar A, Anantha N, Venugopal TC
AFFILIATION: Coordinating Unit, National Cancer Registry Programme of India (Indian Council of Medical Research), Kidwai Memorial Institute of Oncology, Bangalore.
SOURCE: Br J Cancer 1995 Jun;71(6):1348-52
ABSTRACT: Cancer of the cervix is the most common cancer among women in India, constituting between one-sixth to one-half of all female cancers with an age-adjusted incidence rate ranging from 19.4 to 43.5 per 100,000 in the registries under the National Cancer Registry Programme (NCRP) (Annual Reports, NCRP, ICMR). It has been estimated that 100,000 new cases of cancer of the cervix occur in India every year, and 70% or more of these are Stage III or higher at diagnosis. However, the incidence of cancer of the cervix as suggested in this report appears to be on the decline in Bangalore. Besides incidence and clinical stage at presentation knowledge of survival is essential to complete the picture of establishing baseline indicators to monitor and evaluate cancer control programmes. Survival analysis was carried out in 2121 patients diagnosed during 1982-89 in the population of Bangalore, India. The observed 5 year survival was 34.4% and the relative survival 38.3%. Clinical stage at presentation was the single most important variable in predicting survival. The 5 year observed survival for stage I disease was 63.3%, for stage II 44.0%, for stage III 30.3% and for stage IV 5.7%.
TITLE: Ethnicity and variations in the nation's health.
AUTHOR: Balarajan R
AFFILIATION: St Bernards Hospital, Southall, Middlesex, UK.
SOURCE: Health Trends 1995-96;27(4):114-9
ABSTRACT: The variations in the Health of the Nation (HoN) key areas among ethnic minorities living in England and Wales are examined, based on a national mortality study by country of birth for the latest possible period (1988-1992). It addresses the 10 mortality indicators in the HoN White Paper (covering coronary heart disease [CHD] and stroke, cancers, mental illness and accidents), using age-standardised rates adjusted to the European Standard Population. The findings establish variations in the recent health experience of ethnic minorities born outside England and Wales who are now living in England and Wales. CHD among persons aged under 65 years was highest in those born in the Indian Subcontinent, 55% above the normal rate in England and Wales. Caribbeans, and African groups experienced the lowest rates. Stroke mortality under 65 years-of-age was highest in Bangladeshis, followed by other Commonwealth Africans, and then by Caribbeans. Patterns of cancer deaths also varied, with breast cancer mortality rates being lower in all ethnic groups, and lowest in those born in the Indian Subcontinent. By contrast, lung cancer deaths were higher in Irish men and women; lung cancer mortality among Bangladeshi men was significantly higher than Indians and Pakistanis, being only 15% less than that of the rates in England and Wales. Suicides were lowest in Bangladeshis and Pakistanis and highest among Indians and the Irish. Accidental deaths in children were highest in Pakistanis followed by the Irish, who also experienced higher rates among young persons. It is suggested that the HoN strategy should consider setting appropriate and achievable targets, including ones in new areas of relevance to these groups. The National Health Service purchaser/provider framework should respond to the needs of its populations, including ethnic groups.