Ethnic Disparities for Gynecologic Cancers in Israel
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Ethnic Disparities for Gynecologic Cancers in Israel Yfat Kadan 1
&
Ami Fishman 1
&
Limor Helpman 2
Received: 18 May 2019 / Revised: 6 November 2019 / Accepted: 7 November 2019 # W. Montague Cobb-NMA Health Institute 2019
Abstract Background Israel’s unique population is comprised of two main ethnic groups—Jews (75%) and Arabs (21%), with differing socioeconomic, cultural, and genetic profiles. This study’s objective was to evaluate disparities in the incidence, presentation, and outcomes of gynecologic cancers among Israeli women of Arab and Jewish ethnicity. Methods Data on the Israeli female population diagnosed with gynecologic cancers during the years 2000–2012 was obtained from the National Cancer Registry and the National Population Registry. Disease incidence rates by ethnic origin were calculated, and the “Segi World standard population” was used for age standardization. Data for Jewish and Arab patients was compared using chi-square test for categorical variables and T test for continuous variables. Survival outcomes were compared using the log-rank test and Cox proportional hazards modeling. Results Annual ASR (age-standardized rate) for ovarian, cervical, and uterine cancers, are all significantly higher among Israeli women of Jewish ethnicity. Israeli Arab women are diagnosed with cervical cancer at an older age (mean, 60.9 vs 55.9, p < 0.001). Stage distribution for uterine, ovarian, and cervical cancers is similar in both ethnic groups. The age-adjusted hazard ratio for mortality from uterine cancer is significantly lower among Jewish Israeli women compared to Arab Israeli women (HR = 0.67, 95% CI 0.57–0.78, p < 0.0001). During the study period, there was a significant decline in the ASR for ovarian cancer among Jewish Israeli women. The ASR for pre-invasive cervical disease increased significantly in both ethnic groups. Conclusions Disparities in gynecological cancer rates, presentations, and outcomes are evident between two major ethnic groups in Israel. Lower cancer incidence rates among Israeli Arab women are likely multifactorial. Uterine cancer outcomes between the two ethnic groups need to be further assessed in order to identify opportunities for improved outcomes among Israeli Arab women. Keywords Health disparities . Jews . Arabs . Uterine cancer . Ovarian cancer . Cervix cancer
Introduction Israel’s unique population is comprised of two main ethnic groups—Jews (75%) and Arabs (20.7%) [1]. Both ethnicities are also prevalent worldwide: In the USA, for example, approximately 0.5% of the population is ethnically Arab and about 1% is Jewish [2, 3]. In Israel, although residing in the same geographic locale, these populations differ in their
* Yfat Kadan [email protected] 1
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Meir Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tchernichovsky St 59, 4428164 Kefar Sava, Israel
2
Division of Gynecologic Oncology, Juravinski Cancer Center, McMaster University, Hamilton, Canada
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