TY - JOUR
T1 - Similar Survival Between Non-Western Immigrant Patients and Danish-Born Patients with Lymphoma: A Danish Population-Based Study
AU - Simonsen, Mikkel Runason
AU - Maksten, Eva Futtrup
AU - Jakobsen, Lasse Hjort
AU - Severinsen, Marianne Tang
AU - Dann, Eldad J
AU - Frederiksen, Henrik
AU - Niemann, Carsten Utoft
AU - Jørgensen, Judit Mészáros
AU - Clausen, Michael Roost
AU - Starklint, Jørn
AU - Johnsen, Søren Paaske
AU - El-Galaly, Tarec Christoffer
AU - Baech, Joachim
N1 - © 2025 Simonsen et al.
PY - 2025/1/23
Y1 - 2025/1/23
N2 - Purpose: This nationwide Danish cohort study compared overall survival (OS) between non-Western immigrant patients and Danish-born patients with lymphoma in Denmark. Furthermore, differences in clinical and socioeconomic variables were compared, and mediators of OS differences were explored to explain possible outcome differences. Patients and Methods: The study included a total of 540 non-Western patients and 16,294 Danish-born patients diagnosed with lymphoma in the period 2000–2020. Inverse probability weighting and mediation analysis using a natural effects Cox model were used to investigate the causal relationship between immigration status and OS. Results: Indirect effects mediated through differences in performance status and income indicated a trend towards inferior OS for non-Western immigrant patients with HRs of 1.06 (0.99–1.14) and 1.06 (0.99–1.14). However, no total causal effect of immigration status on OS was observed overall (HR: 0.94 [0.79–1.12]) and within subtype-specific analyses, except for classical Hodgkin lymphoma. Conclusion: No significant differences in OS between non-Western immigrant patients and Danish-born patients were discovered. Plain Language Summary: Non-Western immigrant lymphoma patients in Western countries may face multiple challenges, including lower socioeconomic status and insufficient language proficiency, which can make navigating the complexity of modern lymphoma treatment difficult. This study investigated whether the Danish tax-based healthcare system has overcome these challenges and delivered non-Western immigrant patients quality care on the same levels as that of the Danish-born patients. Therefore, using available population based Danish registries, survival between these groups were compared, while adjusting for important clinical differences, and no significant effect of immigration status on survival was found even though non-Western immigrant patients generally had lower socioeconomic status.
AB - Purpose: This nationwide Danish cohort study compared overall survival (OS) between non-Western immigrant patients and Danish-born patients with lymphoma in Denmark. Furthermore, differences in clinical and socioeconomic variables were compared, and mediators of OS differences were explored to explain possible outcome differences. Patients and Methods: The study included a total of 540 non-Western patients and 16,294 Danish-born patients diagnosed with lymphoma in the period 2000–2020. Inverse probability weighting and mediation analysis using a natural effects Cox model were used to investigate the causal relationship between immigration status and OS. Results: Indirect effects mediated through differences in performance status and income indicated a trend towards inferior OS for non-Western immigrant patients with HRs of 1.06 (0.99–1.14) and 1.06 (0.99–1.14). However, no total causal effect of immigration status on OS was observed overall (HR: 0.94 [0.79–1.12]) and within subtype-specific analyses, except for classical Hodgkin lymphoma. Conclusion: No significant differences in OS between non-Western immigrant patients and Danish-born patients were discovered. Plain Language Summary: Non-Western immigrant lymphoma patients in Western countries may face multiple challenges, including lower socioeconomic status and insufficient language proficiency, which can make navigating the complexity of modern lymphoma treatment difficult. This study investigated whether the Danish tax-based healthcare system has overcome these challenges and delivered non-Western immigrant patients quality care on the same levels as that of the Danish-born patients. Therefore, using available population based Danish registries, survival between these groups were compared, while adjusting for important clinical differences, and no significant effect of immigration status on survival was found even though non-Western immigrant patients generally had lower socioeconomic status.
KW - causal inference
KW - epidemiology
KW - mediation analysis
KW - socioeconomics
UR - http://www.scopus.com/inward/record.url?scp=85216947791&partnerID=8YFLogxK
U2 - 10.2147/CLEP.S484797
DO - 10.2147/CLEP.S484797
M3 - Journal article
C2 - 39872603
SN - 1179-1349
VL - 17
SP - 19
EP - 25
JO - Clinical Epidemiology
JF - Clinical Epidemiology
ER -