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Chen G, Barlow M, Down L, Mounce LTA, Merriel SWD, Watson J, Martins T, Bailey SER. Exploring ethnic differences in the distribution of blood test results in healthy adult populations to inform earlier cancer detection: a systematic review. Fam Pract 2024:cmae021. [PMID: 38706165 DOI: 10.1093/fampra/cmae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes. OBJECTIVE This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis. METHODS We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible. RESULTS A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women. CONCLUSIONS There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580.
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Affiliation(s)
- Ge Chen
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Melissa Barlow
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Liz Down
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | - Samuel William David Merriel
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
- Centre for Primary Care & Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Jessica Watson
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tanimola Martins
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
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Down L, Barlow M, Bailey SER, Mounce LTA, Merriel SWD, Watson J, Martins T. Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Med 2024; 22:82. [PMID: 38424555 PMCID: PMC10905783 DOI: 10.1186/s12916-024-03283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Black men have higher prostate-specific antigen (PSA) levels and higher prostate cancer incidence and mortality than White men, while Asian men tend to have lower prostate cancer incidence and mortality than White men. Much of the evidence comes from the USA, and information from UK populations is limited. METHODS This retrospective cohort study used data on patients registered at general practices in England contributing to the Clinical Practice Research Datalink (CPRD) Aurum dataset. Those eligible were men aged 40 and over with a record of ethnicity and a PSA test result recorded between 2010 and 2017 with no prior cancer diagnosis. The aim was to assess the incidence of prostate cancer following a raised PSA test result in men from different ethnic groups. Additionally, incidence of advanced prostate cancer was investigated. Cancer incidence was estimated from multi-level logistic regression models adjusting for potential confounding factors. RESULTS 730,515 men with a PSA test were included (88.9% White). Black men and men with mixed ethnicity had higher PSA values, particularly for those aged above 60 years. In the year following a raised PSA result (using age-specific thresholds), Black men had the highest prostate cancer incidence at 24.7% (95% CI 23.3%, 26.2%); Asian men had the lowest at 13.4% (12.2%, 14.7%); incidence for White men was 19.8% (19.4%, 20.2%). The peak incidence of prostate cancer for all groups was in men aged 70-79. Incidence of prostate cancer diagnosed at an advanced stage was similar between Black and White men. CONCLUSIONS More prostate cancer was diagnosed in Black men with a raised PSA result, but rates of advanced prostate cancer were not higher in this group. In this large primary care-based cohort, the incidence of prostate cancer in men with elevated PSA levels increases with increasing age, even when using age-adjusted thresholds, with Black men significantly more likely to be diagnosed compared to White or Asian men. The incidence of advanced stage prostate cancer at diagnosis was similar for Black and White men with a raised PSA result, but lower for Asian men.
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Affiliation(s)
- Liz Down
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Melissa Barlow
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Sarah E R Bailey
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Luke T A Mounce
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Samuel W D Merriel
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jessica Watson
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tanimola Martins
- Department of Health and Community Sciences, University of Exeter, St Lukes Campus, Heavitree Road, Exeter, EX1 2LU, UK
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Illah O, Adeeko D, Olaitan A, Gentry-Maharaj A. Racioethnic Disparities in Endometrial Cancer Outcomes. Diagnostics (Basel) 2024; 14:417. [PMID: 38396458 PMCID: PMC10887632 DOI: 10.3390/diagnostics14040417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Black women are twice as likely to die from endometrial cancer (EC) compared with white women. This represents one of the worst racioethnic disparities amongst all cancers globally. Compared with white women, black women are more likely to be diagnosed with advanced EC, have more barriers to accessing care and experience increased delays in obtaining an EC diagnosis and commencing treatment. Histological and molecular differences place black women at higher risk of being diagnosed with more aggressive EC subtypes that carry less favourable outcomes. Furthermore, EC diagnostic pathways are less reliable in black women, and black women are less likely to receive evidence-based treatment for EC. This racioethnic disparity in EC outcomes exists both in the UK and US, despite differences in healthcare systems. This review methodically describes the key factors along the patient journey that contribute to the disparity in black women and proposes multifaceted approaches to lessen these gaps.
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Affiliation(s)
- Ojone Illah
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
| | - Deborah Adeeko
- Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6AU, UK
| | - Adeola Olaitan
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
| | - Aleksandra Gentry-Maharaj
- Department of Women’s Cancer, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6DD, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London WC1V 6LJ, UK
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Darko N, Millet N, Usman A, Teece L, Moss EL. Exploring the perspectives of underrepresented voices: Perceptions and experiences of uterine cancer for black African, Caribbean, black British, and mixed-black women in the UK to develop strategies for early symptom presentation. Gynecol Oncol 2024; 180:132-138. [PMID: 38091772 DOI: 10.1016/j.ygyno.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES The uterine cancer (UC) mortality rate in the UK is significantly higher for women who belong to a Black ethnic group compared to those from other ethnic groups. This study aimed to understand the views and experiences of UC amongst Black ethnic minority women in the UK, with a focus on awareness and presentation of red-flag symptoms. METHODS Women of Black African, Caribbean, Black British and Mixed-Black ethnicity were purposefully recruited to participate in focus groups and individual semi-structured interviews. RESULTS Twenty women from different regions in England participated in the study. Reflexive thematic analysis of the data led to the identification of three main themes: 1) Healthcare inequities; 2) Support and sense making with other Black women; and 3) Knowledge dissemination, mobilisation, and empowerment. Perceptions of inequitable healthcare provision and distrust influenced how participants, and their peer networks, approached seeking assistance from healthcare professionals. Concerns were also raised about culturally insensitive information resources, including issues of language, literacy, and representation, all of which served as potential barriers for women within Black ethnic minority groups. CONCLUSIONS The deficiency of targeted knowledge mobilisation and specific UC information aimed at Black ethnicity women living in the UK, reportedly contributes to the dissemination of misconceptions and an atmosphere of apprehension around a UC diagnosis. The insights from this study highlight the significance of designing culturally sensitive strategies to promote informed decision-making and empower the dissemination of accurate health knowledge amongst Black women.
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Affiliation(s)
- N Darko
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - N Millet
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - A Usman
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - L Teece
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - E L Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
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Moss EL, Teece L, Darko N. Uterine cancer mortality and Black women: time to act. Lancet Oncol 2023; 24:586-588. [PMID: 37269839 DOI: 10.1016/s1470-2045(23)00113-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/16/2023] [Accepted: 03/14/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Esther L Moss
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lucy Teece
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Natalie Darko
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, Leicester, UK; College of Life Sciences, University of Leicester, Leicester, UK; School of Media, Communication, and Sociology, University of Leicester, Leicester, UK.
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Limb M. Black women in England are at greater risk of late cancer diagnosis than white women. BMJ 2023; 380:211. [PMID: 36707077 DOI: 10.1136/bmj.p211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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