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Research

Cancer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis

Tara C. Horrill, Lindsey Dahl, Esther Sanderson, Garry Munro, Cindy Garson, Randy Fransoo, Genevieve Thompson, Catherine Cook, Janice Linton and Annette S.H. Schultz
December 18, 2019 7 (4) E754-E760; DOI: https://doi.org/10.9778/cmajo.20190176
Tara C. Horrill
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Lindsey Dahl
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Esther Sanderson
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Garry Munro
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Cindy Garson
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Randy Fransoo
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Genevieve Thompson
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Catherine Cook
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Janice Linton
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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Annette S.H. Schultz
College of Nursing (Horrill, Thompson, Schultz), Rady Faculty of Health Sciences, University of Manitoba; Rady Faculty of Health Sciences (Dhal, Cook), University of Manitoba, Winnipeg, Man.; University College of the North (Sanderson); Cree Nation Tribal Health Centre (Munro), The Pas, Man.; Interlake Reserves Tribal Council (Garson); Manitoba Centre for Health Policy (Fransoo), University of Manitoba; Indigenous Health Library (Linton), University of Manitoba, Winnipeg, Man.
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    Table 1:

    Characteristics of Status First Nations patients with cancer diagnosed between 2004/05 and 2010/11 living on and off reserve in Manitoba

    CharacteristicNo. (%) of patients*p value
    On reserve
    n = 930
    Off reserve
    n = 594
    Age, yr, mean ± SD60.6 ± 14.557.5 ± 14< 0.001
    Sex
     Male456 (49.0)223 (37.5)< 0.001
     Female474 (51.0)371 (62.5)
    Rural residency846 (91.0)266 (44.8)
    Regional Health Authority< 0.001
     Interlake Eastern257 (27.6)81 (13.6)
     Northern428 (46.0)107 (18.0)
     Southern6 (0.6)7 (1.2)
     Prairie Mountain68 (7.3)20 (3.4)
     Winnipeg102 (11.0)66 (11.1)
     Public Trustee69 (7.4)313 (52.7)
    Income quintile< 0.001
     NF12 (1.3)9 (1.5)
     R1 (lowest rural)508 (54.6)79 (13.3)
     R2209 (22.5)43 (7.2)
     R343 (4.6)43 (7.2)
     R475 (8.1)51 (8.6)
     R5 (highest rural)11 (1.2)50 (8.4)
     U1 (lowest urban)49 (5.3)170 (28.6)
     U212 (1.3)67 (11.3)
     U3≤ 538 (6.4)
     U4≤ 532 (5.4)
     U5 (highest urban)≤ 512 (2.0)
    Charlson Comorbidity Index score, mean ± SD1.4 ± 1.41.3 ± 1.30.01
    • Note: NF = not found, SD = standard deviation.

    • ↵* Except where noted otherwise.

    • View popup
    Table 2:

    Cancer stage at diagnosis and site by location

    VariableNo. (%) of patientsp value
    On reserveOff reserve
    Cancer stage
    I202 (21.7)160 (26.9)0.02
    II207 (22.3)133 (22.4)0.95
    III176 (18.9)109 (18.4)0.8
    IV216 (23.2)126 (21.2)0.4
    Unknown129 (13.9)66 (11.1)0.1
    Cancer site
    Bladder≤ 58 (1.3)0.09
    Breast99 (10.6)111 (18.7)< 0.001
    Cervix19 (2.0)26 (4.4)0.009
    Chronic lymphocytic leukemia≤ 5≤ 50.08
    Colorectal153 (16.4)87 (14.6)0.3
    Kidney96 (10.3)40 (6.7)0.02
    Lung and bronchus131 (14.1)74 (12.5)0.4
    Melanoma of the skin≤ 5≤ 5≤ 5
    Non-Hodgkin lymphoma33 (3.5)32 (5.4)0.08
    Ovary25 (2.7)7 (1.2)0.04
    Pancreas19 (2.0)13 (2.2)0.8
    Prostate100 (10.8)34 (5.7)< 0.001
    Stomach18 (1.9)11 (1.8)0.9
    Thyroid10 (1.1)10 (1.7)0.3
    Uterus19 (2.0)19 (3.2)0.2
    Other197 (21.2)113 (19.0)0.3
    • View popup
    Table 3:

    Annual crude and adjusted cancer incidence by location

    YearCountCrude IR per 100 000p valueAdjusted IR per 100 000*p value
    On reserveOff reserveOn reserveOff reserveOn reserveOff reserve
    2004/0511675308.9301.80.9245.1280.10.4
    2005/0612371318.6279.70.4256.3255.40.98
    2006/0713171330.7273.10.2260.8247.30.7
    2007/0812188297.4331.60.4233.6292.40.1
    2008/09154119367.2440.00.1291.0380.30.04
    2009/1016492378.4329.90.3307.2280.30.5
    2010/11159100355.0347.90.9283.3294.80.8
    Overall968616337.8330.40.7247.9287.90.02
    • Note: IR = incidence rate.

    • ↵* Adjusted for age, sex, income quintile and Regional Health Authority area of residence.

    • View popup
    Table 4:

    Trend analysis of annual crude and adjusted cancer incidence rates by location

    MeasureCrude cancer incidenceAdjusted cancer incidence*
    On reserveOff reserveOn reserveOff reserve
    R20.540.310.510.16
    β coefficient (95% CI)10.51 (−0.54 to 21.57)14.49 (−10.39 to 39.63)8.81 (−0.97 to 18.85)8.1 (−13.13 to 29.34)
    • Note: CI = confidence interval.

    • ↵* Adjusted for age, sex, income quintile and Regional Health Authority area of residence.

    • View popup
    Table 5:

    Mortality hazard ratios

    OutcomeHR (95% CI)*
    All-cause mortality — crude1.28 (1.11 to 1.26)
    All-cause mortality 5 yr after diagnosis — adjusted1.18 (0.98 to 1.41)
    Cancer-specific mortality — crude1.09 (0.98 to 1.22)
    Cancer-specific mortality 5 yr after diagnosis — adjusted1.03 (0.90 to 1.19)
    • Note: CI = confidence interval, HR = hazard ratio.

    • ↵* Adjusted for age, sex, Charlson Comorbidity Index score, cancer stage at diagnosis, income quintile and Regional Health Authority area of residence.

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CMAJ Open: 7 (4)
Vol. 7, Issue 4
1 Oct 2019
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Cancer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis
Tara C. Horrill, Lindsey Dahl, Esther Sanderson, Garry Munro, Cindy Garson, Randy Fransoo, Genevieve Thompson, Catherine Cook, Janice Linton, Annette S.H. Schultz
Oct 2019, 7 (4) E754-E760; DOI: 10.9778/cmajo.20190176

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Cancer incidence, stage at diagnosis and outcomes among Manitoba First Nations people living on and off reserve: a retrospective population-based analysis
Tara C. Horrill, Lindsey Dahl, Esther Sanderson, Garry Munro, Cindy Garson, Randy Fransoo, Genevieve Thompson, Catherine Cook, Janice Linton, Annette S.H. Schultz
Oct 2019, 7 (4) E754-E760; DOI: 10.9778/cmajo.20190176
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