Cancer is the second leading cause of death in the United States (US). Immigrants from the Middle East (ME) constitute one of the growing immigrant populations in the US and particularly in California. However, very few studies have examined the cancer characteristics in different generations of ME immigrants compared to Non-Hispanic Whites (NHW). The overall purpose of this dissertation was to analyze the association between ME immigration status and cancer stage at diagnosis and all-cause and cancer-specific incidence and mortality in different generations of ME immigrants and NHW.
We used data from the California Cancer Registry, a population-based dataset, to identify invasive primary incident cancer cases in three population groups: first generation ME immigrants, second or subsequent generations ME immigrants, and NHW. Proportional Incidence Ratio was used to compare the cancer risk of the 15 selected most common cancers in the 3 population. Logistic regression models were fitted to evaluate the risk of advanced cancer stage in the different generations of ME immigrants and NHW. Cox proportional hazard models were applied to calculate hazard ratios with their 95% confidence intervals for all-cause mortality and cancer-specific mortality among the 3 population groups. Breast cancer in females, prostate cancer in males, and colorectal cancer in both genders were examined in the logistic and Cox proportional models.
The results suggest that differences in cancer risk between first generation ME immigrants and NHW change in second or subsequent generations, approaching the risk level of NHW and indicating the impact of acculturation in this immigrant population. The different generations of ME immigrants had higher odds of advanced cancer stage at diagnosis when compared to NHW. However, first generation ME immigrants had lower all-cause mortality in comparison with NHW.
This study is the first to explore the different cancer characteristics in ME immigrants to California. Our novel study highlights the importance of adapting screening interventions tailored to the ME immigrant population in the US with using an appropriate language and taking into consideration the ME immigrants’ specific cultural and religious beliefs.