Tobacco-related cancer mortality among immigrants in France, 2000-2021

Abstract Background Despite a decrease in global prevalence over recent decades in Europe, smoking remains the primary cause of cancer mortality. To date, findings on cancer mortality among immigrants in Europe have been limited in granularity, grouping causes of death or data from multiple host countries. However, cancer mortality trends vary by country of residence, region of birth, sex and cancer type. Country-specific analyses of immigrant tobacco-related cancer mortality are therefore necessary. Methods We used data from France's national mortality registry and population censuses to estimate mortality rates by region of birth for the 2000-2021 period. Sex-stratified direct age-standardized mortality rates (ASMR) with 95% confidence intervals (CI) were calculated for tobacco-related cancer deaths by region of birth and municipal deprivation level. Age-standardized rate ratios (SRR) were calculated to compare mortality in the most deprived and least deprived groups by origin. Analyses were also conducted by sub-period. Results Among tobacco-related cancers, lung cancer mortality trends differed by sex and birth country. Age-standardized rates were highest among non-Southern European women (ASMR 42.1; CI 40.9, 43.4) and Southern European men (130.0; 128.1, 131.9). Lung cancer mortality increased with deprivation level for French (SRRQ5/Q1 1.39), non-Southern European (SRRQ5/Q1 1.41) and Southern European (SRRQ5/Q1 1.31) men as well as non-Southern European women (SRRQ5/Q1 1.18). This trend was not observed in other birth region groups. Most male region of birth groups showed a downwards lung cancer mortality trend over the period, while female group trends varied by origin. Conclusions Immigrants represent groups with heterogeneous lung cancer mortality risks that differ from those in the native population. The results of this study may inform targeted disease prevention and screening programs to reduce inequalities in tobacco-related mortality. Key messages • Region of birth and sex are determinants of tobacco-related cancer mortality in the French population. • The effect of municipal deprivation on mortality is observed in some region of birth groups, notably European men and non-Southern European women.