Differentials in Survival for Childhood Cancer in Australia by Remoteness of Residence and Area Disadvantage

Abstract

Background: It is not known whether improvements in cancer survival over recent decades have benefited children from different geographic locations equally. This is the first study to produce national survival estimates for childhood cancer in Australia by remoteness of residence and area-based socioeconomic status.Methods: The study utilized population-based data from the Australian Paediatric Cancer Registry for children diagnosed with cancer from 1996 onward who were at risk of mortality between January 2001 and December 2006 (n ¼ 6,289). Remoteness was specified according to the Australian Standard Geographical Classification Remoteness Areas, whereas an index of area disadvantage was obtained from census information. Five-year relative survival estimates were produced by the period method for all cancers and the most common diagnostic groups, with corresponding age-sex adjusted mortality hazard ratios calculated using Poisson regression.Results: Overall, children with cancer from remote/very remote areas had a significantly lower survival rate than their counterparts in major cities (HR ¼ 1.55, 95% CI ¼ 1.08-2.23). Survival was also lower for children with leukemia living in inner regional (HR ¼ 1.52, 95% CI ¼ 1.11-2.08) or outer regional areas (HR ¼ 1.53, 95% CI ¼ 1.03-2.28). There was weak evidence (P grad ¼ 0.051) of a trend toward poorer survival by greater area disadvantage for all childhood cancers.Conclusions: Some variation in prognosis by place of residence was present for children with cancer in Australia, particularly among leukemia patients.Impact: Treatment, clinical or area-related factors that contribute to these survival differentials need to be identified. Cancer Epidemiol Biomarkers Prev; 20(8); 1649-56. Ó2011 AACR.

The association between socioeconomic status and survival among children with Hodgkin and non‐Hodgkin lymphomas in a universal health care system

“…However, it is plausible that our findings are inconsistent with those from the US studies because of the different age groups that comprised each cohort (children 0-14 years old vs. AYAs 15-19 years old). Comparisons with other international studies are difficult as the available literature uses variable measures of SES (e.g., parental education level [35], remoteness of residence [36]). …”

Socioeconomic status (SES) and childhood acute myeloid leukemia (AML) mortality risk: Analysis of SEER data

“…These studies have examined individually-based indices such as parental occupation, maternal education and household income [4,6,7] and community-level variables such as poverty and unemployment rates, educational attainment, median household income and crowding [5,8, 22]. Typically such indices are either examined separately, in some form of composite (e.g., summed, averaged), or simultaneously in predictive models, ignoring correlations among variables.…”

“…Pathways from poverty to health outcomes are complex. They are partially determined by differential cumulative exposure to health harming situations (e.g., environmental toxins [26], trauma, chronic stress, and nutritional deprivation [27]) hypothesized to result in prolonged endocrine, immune, and central nervous system over-functioning [28] and biological ‘wear and tear.’ As in other countries [8, 22], mortality risk may be higher for those living in economic/educationally disadvantaged communities in the US due to poor access to healthcare, lack of appropriate pediatric oncology subspecialists, lack of knowledge of cancer diagnosis, treatment and inability to access clinical trials. It is well documented in the US that uninsured children have poorer access to healthcare and poorer outcomes [25, 29–31].…”

“…Socioeconomic status (SES), is a known contributor to pediatric cancer mortality risk [3–9]. While often an individually-based measure of economic, sociological, educational and/or cultural indicators [5], census-based community-level SES measures are also useful predictors of mortality risk [3,5,8,9] and may point toward communities in need of resources to reduce SES-related survival disparities. Specifically within the US, children living in communities with high poverty rates have been found to have greater mortality risk [5,9].…”

Overview of Cancer Registration Research in the Asian Pacific from 2008-2013

“…Some variation in prognosis by place of residence was present, particularly among leukemia patients (Youlden et al, 2011). Children living in remote or very remote areas were 21% less likely to be diagnosed with cancer compared to children in major cities, mainly due to differences in the incidence of leukemias and lymphomas (Youlden et al, 2012b).…”