Understanding mortality differentials of Black adults in Canada.

Abstract

Background: It is not clear whether the increased mortality pattern observed in a prior analysis of the Canadian Census Health and Environment Cohorts for HIV/AIDS, diabetes, prostate cancer, and uterine cancer among Black adults is reflected in incident hospitalization (a marker of severity) or the diagnosis of these diseases, nor is it clear whether disparities exist regarding early screening and survivability.

Methods: To understand the paths that contribute to differential mortality patterns, standard Cox proportional hazard models were used to assess the incidence risk of diagnosis (uterine and prostate cancer) and incident hospitalization (HIV and diabetes) among 161,520 Black adults, compared with 6,866,070 White adults. Competing risk regression was used to evaluate the cumulative risk of death for the four disease outcomes since diagnosis or hospitalization. For the observed differential cancer mortality, mediation analysis was conducted to investigate the role of cancer diagnosis at follow-up (a proxy for delayed diagnosis that is not entirely indicative of late-stage cancer).

Results: Across all examined outcomes, except for uterine cancer, Black adults had elevated incident diagnoses or hospitalizations compared with White adults. Notably, Black males demonstrated a risk of incident prostate cancer and hospitalizations from HIV and diabetes twice as high relative to White males. For Black females, the risk of incident HIV hospitalization was 12 times as high. However, Black females were 15% less likely to be diagnosed with uterine cancer, compared with White females. Cumulative mortality risk analysis showed significantly lower survivability (two times lower) among Black females diagnosed with uterine cancer, relative to White females. Delayed diagnosis mediated a marginally higher proportion of the total differential uterine cancer mortality among Black females (14.9%; 95% confidence interval [CI]: 10.5% to 23.1%), compared with White females (8.9%; 95% CI: 6.3% to 13.9%).

Interpretation: This study unveils substantial parallels between heightened incidence risk and relative mortality for most of the four explored outcomes between Black and White adults in Canada. Notably, the study highlights a lower incident diagnosis of uterine cancer among Black females, despite a relatively higher uterine cancer mortality. Three in every 20 uterine cancer deaths were mediated through the time of uterine cancer diagnosis (relatively delayed in Black females), underscoring the need for targeted interventions and early detection strategies to address health disparities in this population.