Migration and cancer mortality among Colombian migrants in the USA: a death certification study

Vries, Esther de; Arroyave, Ivan; Chayo, Isaac; Pinheiro, Paulo S.

doi:10.1590/S0104-12902024210034en

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Original articles • Saude soc. 33 (1) • 2024 • https://doi.org/10.1590/S0104-12902024210034en copy

Migration and cancer mortality among Colombian migrants in the USA: a death certification study¹ 1 Arroyave was supported by a research grant of the Colombian Ministry of Science, COLCIENCIAS (funding agreement for research 832/2019). Furthermore, this study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Pinheiro was funded partially by Bankhead Coley Grant # 20B16 of the Biomedical research program of the Department of Health of the State of Florida.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

We aim to compare cancer mortality rates of USA Colombian migrants (USA Colombians) to Colombians in their country of origin (CO Colombians). Using Colombian national mortality data and data on cancer deaths among Colombians residing in the states of California, Florida, and New York (USA Colombians) for the period 2008-2012, we estimated sex-specific and age-standardized mortality rates (ASMR), expressed per 100,000 persons. For comparisons between the two populations before and after adjustment for educational level, negative binomial regression models were used to compute Mortality Rate Ratios (MRR). CO Colombians had higher cancer mortality rates compared with USA Colombians (male MRR 1.4 [95%CI: 1.2-1.5], female MRR 1.5 [95%CI: 1.3-1.7]). These differences persisted for most cancers even after adjustment for education. CO Colombians had significantly higher mortality from gastric (MRR 2.6 in males and 2.8 in females) and cervical cancer (MRR 5.0) compared with US Colombians. Educational inequalities in cancer mortality were more pronounced among CO Colombians than among USA Colombians. Lower cancer mortality observed among USA Colombians cannot be attributed to differences in education, an indicator of socio-economic status. Rather, it is likely due to better access to preventive and curative healthcare in the USA.

Keywords:
Migrants; Cancer; Colombia; United States; Mortality

Country/ US State	Cancer Deaths		Population size (person-years) 2008-2012^a
Country/ US State	#	% with higher education	#	% with higher education
USA	2,137	36.3%	2,099,530	46.1%
California	288	51.0%	200,995	57.8%
Florida	1,150	37.1%	1158,265	47.8%
New York	699	28.9%	740,270	40.3%
Colombia	165,222	8.8%	227,415,467	11.9%

	Number of deaths		Age-standardized mortality rates		Adjusted mortality rate ratios (MRR)
			US Colombians	Colombia	MRR adjusted for age^a	MRR adjusted for age and education^a
	US Colombians	Colombia	ASR (95% CI)	ASR (95% CI)	MRR (95% CI)	MRR (95%CI:)
Males
Stomach	85	13,709	5.4 (4.3-7.5)	13.1 (12.9-13.4)	2.8 (2.1-3.3)	2.2 (1.8-2.8)
Colorectal	88	6,131	5.5 (4.4-7.7)	5.9 (5.7-6.0)	1.1 (0.9-1.4)	1.2 (0.9-1.5)
Liver	51	3,867	3.3 (2.4-5.4)	3.8 (3.6-3.9)	1.2 (0.9-1.6)	1.1 (0.8-1.6)
Pancreas	91	3,010	5.8 (4.6-8.0)	2.9 (2.8-3.0)	0.5 (0.4-0.7)	0.6 (0.5-0.7)
Lung	150	11,655	9.3 (7.9-11.7)	11.3 (11.1-11.5)	1.2 (1.0-1.5)	1.1 (0.9-1.4)
Prostate	107	12,086	7.0 (5.7-9.3)	10.9 (10.7-11.1)	1.7 (1.4-2.0)	1.6 (1.3-2.1)
All Cancers Combined	907	81,123	60.0 (55.3-65.3)	76.8 (76.3-77.4)	1.4 (1.2-1.5)	1.3 (1.1-1.5)
Females
Stomach	69	8,782	2.5 (1.9-4.4)	6.9 (6.8-7.1)	2.8 (2.2-3.5)	2.5 (2.0-3.2)
Colorectal	88	7,047	3.4 (2.7-5.3)	5.6 (5.5-5.7)	1.8 (1.5-2.2)	1.7 (1.4-2.1)
Liver	55	4,349	2.1 (1.5-4.0)	3.5 (3.4-3.6)	1.8 (1.4-2.3)	1.6 (1.1-2.4)
Pancreas	96	3,549	3.5 (2.8-5.5)	2.8 (2.7-2.9)	0.8 (0.7-1.0)	0.8 (0.7-1.0)
Lung	172	7,883	6.0 (5.1-8.0)	6.4 (6.2-6.5)	1.0 (0.9-1.2)	1.0 (0.8-1.2)
Breast	181	11,400	6.9 (5.9-9.0)	9.6 (9.4-9.7)	1.4 (1.1-1.6)	1.4 (1.1-1.8)
Cervix	35	7,859	1.3 (0.9-3.3)	6.5 (6.4-6.7)	5.0 (3.6-6.9)	3.8 (2.6-5.7)
Uterus	45	2,291	1.8 (1.3-3.8)	1.9 (1.8-2.0)	1.1 (0.8-1.6)	1.0 (0.8-1.4)
Ovary	84	3,639	3.1 (2.5-5.1)	3.1 (3.0-3.2)	0.9 (0.7-1.2)	0.9 (0.7-1.2)
All Cancers Combined	1,230	84,099	45.8 (43.2-49.2)	68.4 (67.9-68.9)	1.5 (1.3-1.7)	1.3 (1.1-1.6)

	Lower Education Level		Higher Education Level
	MRR	95% CI	MRR	95% CI
Males
Stomach	2.75*	(2.08; 3.64)	1.51*	(1.07; 2.12)
Colorectal	1.01	(0.77; 1.31)	1.37	(0.97; 1.94)
Liver	1.08	(0.77; 1.51)	1.22	(0.75; 1.98)
Pancreas	0.63*	(0.46, 0.84)	0.54*	(0.40; 0.74)
Lung	1.21	(0.94; 1.55)	0.94	(0.71; 1.23)
Prostate	2.05*	(1.58; 2.67)	1.19	(0.90; 1.58)
All Cancers Combined	1.44*	(1.32; 1.59)	1.12*	(1.00; 1.25)
Females
Stomach	2.87*	(2.15; 3.82)	1.70*	(1.11; 2.60)
Colorectal	1.63*	(1.28; 2.09)	2.09*	(1.35; 3.23)
Liver	1.68*	(1.24; 2.29)	1.20	(0.68; 2.10)
Pancreas	0.74*	(0.59; 0.93)	1.07	(0.69; 1.64)
Lung	0.97	(0.81; 1.15)	0.89	(0.58; 1.38)
Breast	1.40*	(1.16; 1.70)	1.40*	(1.11; 1.76)
Cervix	4.07*	(2.78; 5.94)	3.34*	(1.66; 6.73)
Uterus	1.40	(0.94; 2.09)	0.64	(0.41; 1.00)
Ovary	0.95	(0.72; 1.25)	0.88	(0.62; 1.26)
All Cancers Combined	1.44	(1.34; 1.55)	1.23*	(1.10; 1.38)

	Colombians				US-Colombians
	Males		Females		Males		Females
	MRR	95% CI	MRR	95% CI	MRR	95% CI	MRR	95% CI
Stomach	1.92*	(1.79; 2.08)	1.85*	(1.67; 2.00)	1.04	(0.67; 1.61)	0.94	(0.55; 1.64)
Colorectal	0.85*	(0.72; 0.99)	1.20*	(1.10; 1.32)	1.16	(0.75; 1.79)	1.54	(0.92; 2.63)
Liver	1.19	(0.95; 1.47)	1.85*	(1.27; 2.70)	1.28	(0.71; 2.33)	1.08	(0.56; 2.08)
Pancreas	0.78*	(0.70; 0.87)	1.05	(0.93; 1.19)	0.63	(0.43; 1.00)	1.47	(0.88; 2.44)
Lung	1.45*	(1.20; 1.67)	1.35*	(1.12; 1.64)	1.08	(0.69; 1.67)	1.02	(0.70; 1.49)
Prostate	1.09	(0.94; 1.27)			0.59	(0.40; 0.86)
Breast^a			0.79	(0.61; 1.04)			0.83	(0.61; 1.15)
Cervix			2.94*	(2.50; 3.57)			2.33*	(1.03; 5.26)
Uterus			1.49*	(1.28; 1.75)			0.57	(0.30; 1.09)
Ovary^a			1.10	(0.19; 6.25)			0.78	(0.48; 1.25)
All Cancers Combined	1.18*	(1.02; 1.35)	1.22*	(1.03; 1.45)	0.88	(0.76; 1.01)	0.95	(0.74; 1.23)

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. Av. dr. Arnaldo, 715, Prédio da Biblioteca, 2º andar sala 2, 01246-904 São Paulo - SP - Brasil, Tel./Fax: +55 11 3061-7880 - São Paulo - SP - Brazil
E-mail: saudesoc@usp.br

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[1] Correspondence Ivan Arroyave National School of Public Health, University of Antioquia, Medellin, Colombia. Calle 62 #52-59, Medellin, Colombia. PO 050010474.