Does the 'Scottish effect' apply to all ethnic groups?

All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study

R. S. Bhopal, N. Bansal, M. Steiner, D. H. Brewster

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32 Citations (Scopus)
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Abstract

Background and objectives: Although ethnic group variations in cancer exist, no multiethnic, populationbased, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in allcancer, and lung, colorectal, breast and prostate cancers. Design, setting, population, measures and analysis: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups. Results: For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups. Conclusions: The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of costeffectiveness of screening, given comparatively low cancer rates.
Original languageEnglish
Article numbere001957
JournalBMJ Open
Volume2
Issue number5
DOIs
Publication statusPublished - 25 Sep 2012

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Ethnic Groups
Colorectal Neoplasms
Lung Neoplasms
Prostatic Neoplasms
Cohort Studies
Breast Neoplasms
Health
Neoplasms
Population
Economics
Confounding Factors (Epidemiology)
Censuses
Longitudinal Studies
Reference Values
Retrospective Studies
Odds Ratio
Databases

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Does the 'Scottish effect' apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study. / Bhopal, R. S.; Bansal, N.; Steiner, M.; Brewster, D. H.

In: BMJ Open, Vol. 2, No. 5, e001957, 25.09.2012.

Research output: Contribution to journalArticle

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abstract = "Background and objectives: Although ethnic group variations in cancer exist, no multiethnic, populationbased, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in allcancer, and lung, colorectal, breast and prostate cancers. Design, setting, population, measures and analysis: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95{\%} CI were calculated for first cancers. In the results below, 95{\%} CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups. Results: For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups. Conclusions: The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of costeffectiveness of screening, given comparatively low cancer rates.",
author = "Bhopal, {R. S.} and N. Bansal and M. Steiner and Brewster, {D. H.}",
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AU - Bhopal, R. S.

AU - Bansal, N.

AU - Steiner, M.

AU - Brewster, D. H.

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PY - 2012/9/25

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N2 - Background and objectives: Although ethnic group variations in cancer exist, no multiethnic, populationbased, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in allcancer, and lung, colorectal, breast and prostate cancers. Design, setting, population, measures and analysis: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups. Results: For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups. Conclusions: The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of costeffectiveness of screening, given comparatively low cancer rates.

AB - Background and objectives: Although ethnic group variations in cancer exist, no multiethnic, populationbased, longitudinal studies are available in Europe. Our objectives were to examine ethnic variation in allcancer, and lung, colorectal, breast and prostate cancers. Design, setting, population, measures and analysis: This retrospective cohort study of 4.65 million people linked the 2001 Scottish Census (providing ethnic group) to cancer databases. With the White Scottish population as reference (value 100), directly age standardised rates and ratios (DASR and DASRR), and risk ratios, by sex and ethnic group with 95% CI were calculated for first cancers. In the results below, 95% CI around the DASRR excludes 100. Eight indicators of socio-economic position were assessed as potential confounders across all groups. Results: For all cancers the White Scottish population (100) had the highest DASRRs, Indians the lowest (men 45.9 and women 41.2) and White British (men 87.6 and women 87.3) and other groups were intermediate (eg, Chinese men 57.6). For lung cancer the DASRRs for Pakistani men (45.0), and women (53.5), were low and for any mixed background men high (174.5). For colorectal cancer the DASRRs were lowest in Pakistanis (men 32.9 and women 68.9), White British (men 82.4 and women 83.7), other White (men 77.2 and women 74.9) and Chinese men (42.6). Breast cancer in women was low in Pakistanis (62.2), Chinese (63.0) and White Irish (84.0). Prostate cancer was lowest in Pakistanis (38.7), Indian (62.6) and White Irish (85.4). No socio-economic indicator was a valid confounding variable across ethnic groups. Conclusions: The 'Scottish effect' does not apply across ethnic groups for cancer. The findings have implications for clinical care, prevention and screening, for example, responding appropriately to the known low uptake among South Asian populations of bowel screening might benefit from modelling of costeffectiveness of screening, given comparatively low cancer rates.

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