Fecal occult blood test screening uptake among immigrants from Muslim majority countries: A retrospective cohort study in Ontario, Canada

Abstract

BackgroundColorectal cancer (CRC) is the second and third highest cause of cancer deaths among Canadian men and women, respectively. Population‐based screening through fecal occult blood testing (FOBT) has been proven to be effective in reducing CRC morbidity and mortality. Although participation in Ontario's organized CRC screening program has been increasing steadily since 2008, its uptake remains low among recent immigrant populations despite the known benefits of screening. To promote participation in CRC screening, it is imperative to understand both individual and system level barriers and enablers. Although a number of immigrant and nonimmigrant factors have been associated with low participation, there is a dearth of knowledge related to the religious affiliation in CRC screening uptake. Our study is among the first to examine this issue in Ontario, one of the most ethnically diverse Canadian provinces and preferred settlement destinations for immigrants.MethodsWe conducted a population‐based retrospective cohort study using linked health care administrative databases. Our cohort included Ontario residents, age 50‐74 who were eligible for FOBT from 1 April 2013 to 31 March 2015.ResultsWe found that immigrants from the Middle East and North Africa and Eastern Europe and Central Asia had the lowest rates of screening. Furthermore, being born in a Muslim‐majority country was associated with lower FOBT screening even after controlling for other confounders including world region and income (ie, overall adjusted relative risk (ARR) of screening 0.92 [95% CI 0.90‐0.93]). Moreover, being enrolled in a primary care model, having a female primary care provider and having an internationally trained physician were associated with increased screening among immigrants from Muslim‐majority countries.ConclusionsThese findings can inform future efforts to improve screening uptake like: enhancing access to primary care providers and enrollment in primary care models, targeted FOBT education for male providers and providers not in a primary care model, development of culturally sensitive and appropriate educational materials, and use of interactive approaches for communication of cancer screening information.

Towards a better understanding between non-Muslim primary care clinicians and Muslim patients: A literature review intended to reduce health care inequities in Muslim patients

“…One study from Chicago, which included a significant number of African American Muslim women along with Arab American and South Asian American Muslim women, did not confirm the effect of modesty concerns on cervical cancer screening, perhaps because it examined both recent immigrants and Muslims who had resided in the area for longer periods of time. [67] Interestingly, all of the included studies found that a relationship with a primary care provider resulted in improved screening rates [65] , [66] , [67] , [68] , [69] , [70] , [71] , which supports the role of primary care in cancer screening. The challenges and barriers mentioned previously may be more prevalent for Muslim women.…”

“…One of the aims of primary care is to prevent disease or to detect disease before it negatively affects patients’ health. The benefit of screening is highly dependent on the proportion of the population participating in testing, and lack of understanding and accommodation of Islamic religious requirements may increase reluctance to utilize healthcare [64] and negatively impact preventive care such as colorectal [65] , cervical [66] , [67] , and breast cancer [68] screening rates, contributing to delayed diagnosis and inequitable outcomes. However, this evidence is limited by most of studies being performed in recent Muslim immigrants and may not be generalizable to the greater Muslim community.…”

Suicide and Self-Harm Among Immigrant Youth to Ontario, Canada From Muslim Majority Countries: A Population-Based Study

“…18 There were three exposure groups defined as (1) Muslim majority country (>50% identify as Muslim), (2) moderate proportion Muslim country (≥10% to ≤50% identify as Muslim) and (3) Muslim minority country (<10% identify as Muslim). Similar assignment of each country to a Muslim proportion has been used in other studies, as individual-level measures of religion are not measured or available across the population 19 ‐ 21 and groupings were congruent with proportions identifying as Muslim from the United Nations Demography Yearbook. 22…”

“…18 There were three exposure groups defined as (1) Muslim majority country (>50% identify as Muslim), (2) moderate proportion Muslim country (≥10% to ≤50% identify as Muslim) and (3) Muslim minority country (<10% identify as Muslim). Similar assignment of each country to a Muslim proportion has been used in other studies, as individual-level measures of religion are not measured or available across the population [19][20][21] and groupings were congruent with proportions identifying as Muslim from the United Nations Demography Yearbook. 22 A secondary exposure was generation status with firstgeneration immigrants not born in Canada and arriving after their birth date, and second-generation immigrants born in an Ontario hospital with a mother with an IRCC immigration record from or after 1985.…”

Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol

“…Equivalent data are not available for Canadian comparisons or to inform policy. However, many studies of health disparities in cancer screening in Canada show that new immigrants have significantly lower cancer screening rates, which contributes to disparities in cancer treatment outcomes 83–95. Groups such as Indigenous people and recent immigrants have more than one risk factor related to SDOH, increasing their likelihood of poorer health outcomes 96.…”