All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales

Harrison, Joseph; Sullivan, Frank; Keenan, Katherine; Kulu, Hill

Abstract

Background

This paper identifies differences in all-cancer incidence and mortality between Pakistani-born (PB), Bangladeshi-born (BB), their descendants, and the White British (WB) in England and Wales. Pakistanis and Bangladeshis are the most marginalised and disadvantaged groups in England and Wales yet, are found to have low cancer mortality and low all-cause mortality. Previous studies though have not looked at generational differences, applied individual-level data nor separated Pakistanis and Bangladeshis from each other and other Asian groups.
Methods

We use the Office for National Statistics Longitudinal Study of England and Wales which is a 1% representative sample of the population. We apply event history analysis on a study period from 1971 to 2016, following individuals from age 20 until a first cancer incidence, censoring at emigration or death. We observe 10,885,500 person-years and 71,926 cancer incidences for WB; 125,700 person-years and 295 events for PB; 53,900 person-years and 113 events for BB and 26,900 person-years and 24 events for descendants. Following incidence, we study a maximum of ten years until a death from cancer, or censoring. In this second analysis on mortality our sample has 329,700 person-years and 31,689 cancer deaths for WB; 1,200 person-years and 104 events for PB; 400 person-years and 50 events for BB and 100 person-years and 10 events for descendants.
Results

Results from the fully adjusted models show that the risk of cancer incidence is lower for PB, BB and descendants compared to the WB native group. Estimated hazard ratio (HR) equals 0.42 for PB (95% confidence interval (CI): 0.38–0.47), for BB HR is 0.38 (CI: 0.32–0.46) and, for descendants HR is 0.36 (CI: 0.24–0.54). Results for cancer mortality after incidence show HR for PB is 0.93 (CI: 0.76–1.12), for BB it is 0.95 (CI: 0.72–1.25) and for descendants HR equals 1.62 (CI: 0.87–3.02 - significant at 90%).
Conclusions

Using high quality representative data, we show that lower incidence of cancer and not better survival is the driver of the low cancer mortality previously found. This advantage persists across immigrant generations, but all-cancer mortality following incidence may be elevated for descendants.

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2024
• Online Publication Date: Dec 2, 2024
• Deposit Date: May 12, 2025
• Publicly Available Date: May 13, 2025
• Journal: BMC Public Health
• Electronic ISSN: 1471-2458
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 1
• DOI: https://doi.org/10.1186/s12889-024-20813-1
• Additional Information: Received: 10 October 2023; Accepted: 21 November 2024; First Online: 2 December 2024; Change Date: 18 December 2024; Change Type: Correction; Change Details: A Correction to this paper has been published:; Change Details: https://doi.org/10.1186/s12889-024-20967-y; : ; : The paper is part of a project that was granted ethical approval in April 2021 by the School of Geography and Sustainable Development Ethics Committee, acting on behalf of the University Teaching and Research Ethics Committee (UTREC) of the University of St Andrews, Scotland, United Kingdom. The paper uses data from the Office for National Statistics - Longitudinal Study. The ONS Longitudinal Study (LS) is constructed making secondary use of the data collected for research purposes. It is made available to accredited researchers in de-identified form through the Secure Research Service. This research, “All-cancer incidence and mortality in Pakistanis, Bangladeshis, and their descendants in England and Wales”, including access to and use of LS data, was granted approval under the Digital Economy Act 2017 by the UK Statistics Authority’s Research Accreditation Panel (RAP). The role of the RAP is to ensure that the process for granting access to de-identified data to accredited researchers is independent, consistent and transparent. The RAP assesses each project against several criteria including whether the project has successfully completed a formal ethical review. This project was accredited on 13 July 2021.; : Not applicable.; : The authors declare no competing interests.