Routes to cancer diagnosis for migrants in Denmark: a population-based nationwide cohort study

Migrants are often diagnosed with cancer at more advanced stages than the background population, resulting in poorer prognosis. The route to cancer diagnosis is associated with the prognosis, but little is known about the diagnostic pathways for migrants. This study aimed to describe the routes to diagnosis (RtD) for migrants in Denmark and compare these with the RtD for patients of Danish origin. We conducted a nationwide cohort study based on Danish registry data, including patients aged ≥ 18 years who were diagnosed with incident cancer between 2014 and 2018 (n = 154,647, including 8066 migrants). Using the UN M49 Standard, we categorised the study population into 15 groups based on country or region of origin (defined according to parental birth country or citizenship), including 14 migrant groups and a reference group of Danish origin. Each patient was assigned to one of six specified RtD. Using multinomial logistic regression models, we assessed associations between migrant groups and RtD. A total of 44.5% of all cancer patients were diagnosed through a primary care cancer patient pathway (CPP), with variations across migrant groups. Compared with patients of Danish origin, a higher risk of diagnosis via an unplanned hospital admission relative to a CPP from primary care was seen for migrants from the former Yugoslavia (relative risk ratio (RRR) 1.30, 95% CI 1.06–1.60), Germany (RRR 1.34, 95% CI 1.12–1.59), Western Asia (RRR 1.61, 95% CI 1.28–2.02), Türkiye (RRR 1.67, 95% CI 1.29–2.15) and Africa (2.02, 95% CI 1.58–2.60). Some migrant groups experienced higher diagnosis rates via unplanned hospital admission compared with patients of Danish origin, which could impact their prognosis. The results underline the importance of strengthening cancer diagnostic pathways for migrant populations.