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Background: In Germany, about 20% of the total population have a migration background. Differences exist between migrants and non-migrants in terms of health care access and utilisation. Colorectal cancer is the second most common malignant tumour in Germany, and incidence, staging and survival chances depend, amongst other things, on ethnicity and lifestyle. The current study investigates whether stage at diagnosis differs between migrants and non-migrants with colorectal cancer in an area of high migration and attempts to identify factors that can explain any differences.
Methods/Design: Data on tumour and migration status will be collected for 1,200 consecutive patients that have received a new, histologically verified diagnosis of colorectal cancer in a high migration area in Germany in the previous three months. The recruitment process is expected to take 16 months and will include gastroenterological private practices and certified centres for intestinal diseases. Descriptive and analytical analysis will be performed: the distribution of variables for migrants versus non-migrants and participants versus non-participants will be analysed using appropriate χ2-, t-, F- or Wilcoxon tests. Multivariable, logistic regression models will be performed, with the dependent variable being the dichotomized stage of the tumour (UICC stage I versus more advanced than UICC stage I). Odds ratios and associated 95%-confidence intervals will be calculated. Furthermore, ordered logistic regression models will be estimated, with the exact stage of the tumour at diagnosis as the dependent variable. Predictors used in the ordered logistic regression will be patient characteristics that are specific to migrants as well as patient characteristics that are not. Interaction models will be estimated in order to investigate whether the effects of patient characteristics on stage of tumour at the time of the initial diagnosis is different in migrants, compared to non-migrants.
Discussion: An association of migration status or other socioeconomic variables with stage at diagnosis of colorectal cancer would be an important finding with respect to equal health care access among migrants. It would point to access barriers or different symptom appraisal and, in the long term, could contribute to the development of new health care concepts for migrants.
Trial registration: German Clinical Trials Register DRKS00005056.
This study addresses the situation of the Sorbs, an indigenous minority living in Lusatia, Germany. Under the overarching rubric of ethnic and nationalist projects, women are usually symbolized as the guardians of culture and language. Women’s experiences as subjects in everyday life and in multi-facetted social practices therefore become veiled. The main concern in this book is to discuss how the women who identify themselves as/with Sorbs studied here construct their identities in the modern world, how they approach a sense of self and how they position themselves in their everyday lives, what kind of processes they undergo in their identity construction, and which factors are implicated in the formation of these identities. Investigating the Sorbian minority as the research subject and focusing on the female gender primarily involves intersections of ethnicity and gender, which are the points of departure for this study. As the research progresses, women’s gradual active construction of gender and ethnicity while living their everyday lives reveals a construction of multifarious and complex identifications across differences of gender, ethnicity, culture, religion and class. The results of research create Sorbian culture anew, craft Sorbian identity afresh and render the notion of Sorbian women in new terms. New meanings encased in these conceptions actually contain an active and transformative impetus. This thrust forces these ideas to undergo a process of redefinition. It is the life experiences people have in everyday practices that impel us to envisage identity construction as a dynamic, never-ending and open-ended articulation of one’s positionings.