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ScienceDirect www.ejso.com
EJSO 41 (2015) 270
Correspondence
Ethnicity and emergency presentation of colon cancer
Dear Editor, We wish to thank our British colleagues for their encouraging interest in our work. We agree that ethnicity is another important aspect of socioeconomic position that was not further analysed in our study. Just as Drs. Askari and Faiz, we expected the rate of emergency presentation of colon cancer to be higher among patients born abroad. However, for native Swedes with colon cancer, the reported rate was 23.4% compared to 21.5% for patients born in other countries (c2 ¼ 2.8; p ¼ 0.10). The lowest rate was found among patients born outside Europe (55/265; 20.8%). We added country of birth (Sweden e other) to our multivariate regression model but it did not change the previous outcome. There was no screening program operating at the time of the study, and this may have contributed to the lack of difference in the rate of emergencies. Ambiguity concerning the definition of “emergency” itself in the reports is another aspect. In our opinion, colon cancer patients born in other countries make up a very heterogenous group. The majority of foreign-born patients in our study were from neighbouring Nordic countries. Other subgroups of immigrants or refugees may represent completely different experiences, potentially affecting their rate of emergency presentation of cancer. Unfortunately our study was based on only two regions in Sweden, including no more than 2856 cases classified as emergencies and among them just 318 (11.1%)
DOI of original article: http://dx.doi.org/10.1016/j.ejso.2014.01.024 http://dx.doi.org/10.1016/j.ejso.2014.10.063 0748-7983/Ó 2014 Elsevier Ltd. All rights reserved.
born abroad. We will definitely consider a larger nationwide study, to make possible further subanalyses by country, or at least by region of birth. One effect of globalization will be an increasing proportion of colorectal cancer patients born in other countries in the future, and we appreciate that Drs. Askari and Faiz initiated the discussion. Conflict of interest statement None. H. Gunnarsson Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden A. Ekholm Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden L.I. Olsson* Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden *Corresponding author. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital L1:00, 171 76 Stockholm, Sweden. E-mail address: [email protected] Accepted 26 October 2014
ScienceDirect www.ejso.com
EJSO 41 (2015) 270
Correspondence
Ethnicity and emergency presentation of colon cancer
Dear Editor, We wish to thank our British colleagues for their encouraging interest in our work. We agree that ethnicity is another important aspect of socioeconomic position that was not further analysed in our study. Just as Drs. Askari and Faiz, we expected the rate of emergency presentation of colon cancer to be higher among patients born abroad. However, for native Swedes with colon cancer, the reported rate was 23.4% compared to 21.5% for patients born in other countries (c2 ¼ 2.8; p ¼ 0.10). The lowest rate was found among patients born outside Europe (55/265; 20.8%). We added country of birth (Sweden e other) to our multivariate regression model but it did not change the previous outcome. There was no screening program operating at the time of the study, and this may have contributed to the lack of difference in the rate of emergencies. Ambiguity concerning the definition of “emergency” itself in the reports is another aspect. In our opinion, colon cancer patients born in other countries make up a very heterogenous group. The majority of foreign-born patients in our study were from neighbouring Nordic countries. Other subgroups of immigrants or refugees may represent completely different experiences, potentially affecting their rate of emergency presentation of cancer. Unfortunately our study was based on only two regions in Sweden, including no more than 2856 cases classified as emergencies and among them just 318 (11.1%)
DOI of original article: http://dx.doi.org/10.1016/j.ejso.2014.01.024 http://dx.doi.org/10.1016/j.ejso.2014.10.063 0748-7983/Ó 2014 Elsevier Ltd. All rights reserved.
born abroad. We will definitely consider a larger nationwide study, to make possible further subanalyses by country, or at least by region of birth. One effect of globalization will be an increasing proportion of colorectal cancer patients born in other countries in the future, and we appreciate that Drs. Askari and Faiz initiated the discussion. Conflict of interest statement None. H. Gunnarsson Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden A. Ekholm Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden L.I. Olsson* Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden Centre for Clinical Research, Eskilstuna, Uppsala Universitet, Sweden *Corresponding author. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital L1:00, 171 76 Stockholm, Sweden. E-mail address: [email protected] Accepted 26 October 2014
