Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia

Abstract

BackgroundPublic concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period.MethodsData for cases diagnosed in New South Wales (NSW) in 1980–2008 (n = 651,245) were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR) with 95% confidence intervals (CI) among people diagnosed with cancer.ResultsIncreased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13–1.17), and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03–1.06). People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98–1.01 and SHR 0.91, 95% CI 0.90–0.92 for people born in other English and non-English speaking countries, respectively). An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04–1.10 for 1980–1989; SHR 1.14, 95% CI 1.12–1.17 for 1990–1999; and SHR 1.24, 95% CI 1.21–1.27 for 2000–2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis).ConclusionsThere is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.

Short and long course neoadjuvant therapy compared for management of locally advanced rectal cancer: 11 years' experience at a regional centre

“…It is further reassuring that despite our demography suggesting geographic and socioeconomic barriers (Table ), our oncological and surgical outcomes were comparable to other centres and trials . These findings contrast with reports in Australia and other developed countries with public healthcare systems which have found geographic and socioeconomic variations in patient outcomes for rectal cancer …”

Geographic variations in stage at diagnosis and survival for colorectal cancer in Australia: A systematic review

“…The pattern of results was not consistent across States and Territories or across studies applying different geographical classifications. All four studies from New South Wales showed significant geographical disparity in survival rates with poorer survival in non‐metropolitan areas; however, these findings differed when colon and rectal cancer were analysed separately (Cancer Institute NSW, ; Chen et al, ; Jong et al, ; Tervonen et al, ). Four of five studies in Queensland populations showed poorer survival with increasing distance from a major city (Baade, Dasgupta, Aitken, & Turrell, , ; Cramb, Mengersen, & Baade, ; Cramb, Mengersen, Turrell, & Baade, ); however, none of the studies conducted in Western Australia ( N = 3) found significant geographic disparity (Hall et al, ; Martin et al, ; Threlfall & Thompson, ), and mixed results were evident in South Australian samples (Beckmann et al, ; Hocking et al, ; PHIDU, ; Roder et al, ; Singla, Broadbridge, Mittinty, Beeke, & Maddern, ; Wilkinson & Cameron, ) and using national data (Australian Institute of Health & Welfare, , , ; Coory, Ho, & Jordan, ).…”

“…RR: Major City (ref); Inner regional: RR 0.90 (0.51-1.56); Chen et al, 2015;Jong et al, 2004;Tervonen et al, 2017). Four of five studies in Queensland populations showed poorer survival with increasing distance from a major city (Baade, Dasgupta, Aitken, & Turrell, 2011aCramb, Mengersen, & Baade, 2011;Cramb, Mengersen, Turrell, & Baade, 2012); however, none of the studies conducted in Western Australia (N = 3) found significant geographic disparity (Hall et al, 2005;Martin et al, 2015;Threlfall & Thompson, 2015), and mixed results were evident in South Australian samples Hocking et al, 2014;PHIDU, 2012;Roder et al, 2015;Singla, Broadbridge, Mittinty, Beeke, & Maddern, 2014;Wilkinson & Cameron, 2004) For instance, there was a trend for the lowest survival rates to be observed for inner and outer regional areas rather than remote or very remote areas.…”

Socioeconomic environment and disparities in cancer survival for 19 solid tumor sites: An analysis of the French Network of Cancer Registries (FRANCIM) data

“…However, some of the potential explanations mentioned above as well as previous research suggest that not only individual but also contextual and environmental factors might contribute to social inequalities in cancer survival. Indeed, several population‐based studies from different countries have shown that patients living in the most deprived areas experienced lower survival rates than those living in the most affluent ones, for most of the cancer sites …”