Cancer Survival in First Nation and Métis Adults in Canada: Follow-up of the 1991 Census Mortality Cohort

Internationally, Indigenous persons tend to have poorer cancer survival than their non-Indigenous peers. Measuring cancer survival among Indigenous populations presents a particular set of challenges owing largely to their small share of the population and a lack of reliable and valid ethnic identifiers in cancer registries and vital statistics registries. The objectives of this thesis were to explore these challenges and how they are or are not overcome internationally, to produce the first Canada-wide estimates of cancer survival for First Nations and MĂŠtis, and to estimate the extent to which different methods of measuring cancer survival yield different results in this application. The systematic review conducted to achieve the first objective revealed that the majority of studies of this topic internationally use a cause-specific approach to measuring survival and that despite common threats to validity posed by information biases, rarely discussed these risks or their potential consequences. Data from the 1991 Census Mortality Cohort, a linkage of the 1991 Long Form Census to the Canadian Cancer Registry and the Canadian Mortality Database through to 2009, were used to accomplish the second and third objectives. Compared to non-Aboriginal cohort members, First Nation and MĂŠtis people had poorer survival for nearly all of the most common cancers and the disparity remained after taking differences in income and rurality into account. The differences in results yielded by common methods for survival analysis were shown to vary depending on the population, the type of cancer and whether survival itself or survival disparities were being measured. Taken together, this work advances our knowledge of cancer disparities between First Nation, MĂŠtis and non-Aboriginal people in Canada and our understanding of how the data and methods we use impact the magnitude of disparities we measure.Ph.D.2018-07-08 00:00:0