Days Spent at Home before Death from Cancer for Immigrants and Long-Term Residents in Ontario, Canada.

Background: Time at home before death is an emerging patient-centered metric of quality end-of-life care. It is unknown if immigrants who die from cancer in Ontario spend less time at home near the end of life. Objective: Compare the number of days at home (DAH) in the last six months of life for immigrants and long-term residents (LTRs) who die from cancer. Methods: Population-based cohort study (January 1, 2005 to December 31, 2013) using administrative databases. Participants were adults (≥18 years) who died from cancer in Ontario. Immigrants were defined as those who immigrated from 1985 onward. The outcome was DAH in the last six months of life. Analysis included univariate and multivariable regression, adjusting for patient and disease characteristics. Subgroup analyses assessed DAH by immigration class, time since immigration, and region of birth. Sensitivity analyses excluded patients with breast and prostate cancer to examine for sex differences. Results: Seventy-two thousand nine hundred eighty-eight individuals (3988 immigrants) were identified. Immigrants spent fewer DAH in the last six months (unadjusted 162 days vs. 164 days, p < 0.001). This remained statistically significant after adjusting (p = 0.0087). DAH varied by immigration class and region of birth. Sensitivity analyses suggest a sex difference in end-of-life time spent at home. Conclusions: Immigrants who die from cancer in Ontario spend fewer DAH before death than LTRs. This may be due to patient preferences, inequitable access to services, or availability of local relatives for support. Further research is needed to understand the causes of this association.

Disease associations with isolated elevations of each of the four IgG subclasses.

PURPOSE: Immunoglobulin G4-related disease (IgG4-RD) is a relatively newly defined disease entity that refers to a group of immune-mediated disorders that have certain histopathologic, serologic, and clinical features in common. IgG4-RD is often associated with elevated serum IgG4. The discovery of IgG4-RD highlights the scarcity of literature examining elevations in other IgG subclasses and their potential associations to disease. In this retrospective chart review study, we aim to address that gap, by exploring disease associations in patients with isolated IgG subclass elevations. METHODS: We identified 552 patients with an isolated elevation of one of the IgG subclasses, and performed a systematic chart review to identify the diagnoses of those patients. We examined the distribution of diagnoses, using the Fisher's exact test to determine if a diagnosis was significantly associated with an isolated elevation in one of the subclasses. RESULTS: Autoimmune pancreatitis, aspirin-exacerbated respiratory disease (AERD), nasal polyps, eosinophilia, and celiac disease were significantly associated with an isolated elevation in IgG4. Hepatitis C and monoclonal gammopathy were significantly associated with isolated elevations in IgG1. Rheumatoid arthritis (RA) was associated with both an isolated elevation in IgG1 and IgG3. Hypothyroidism and irritable bowel syndrome (IBS) were significantly associated with isolated elevations in IgG2. CONCLUSION: These results confirmed some established associations between autoimmune pancreatitis, AERD, nasal polyps, and eosinophilia and elevated serum IgG4, and between monoclonal gammopathy and hepatitis C with elevated serum IgG1. It uncovered novel associations between RA and elevated IgG1 and IgG3, hypothyroidism and IBS and elevated IgG2, and between celiac disease and elevated IgG4.