Socio‐demographic factors drive regional differences in participation in the National Bowel Cancer Screening Program – An ecological analysis

Abstract

A ustralia performs exceptionally well in improving the overall survival of people diagnosed with cancer. 1 However, advances in early detection and treatment of cancer may not benefit all Australians equally. Significant disparities in health outcomes -including cancer mortality -continue to exist, most notably among people living in rural, regional and remote areas of Australia and Indigenous Australians. 2-4Colorectal cancer (CRC) or bowel cancer is the most common cancer for men and women combined and is the second leading cause of cancer death in Australia. 5 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Aust NZ J Public Health. 2018; 42:92-7; doi: 10.1111/1753 Abstract Objective: To examine if geographic variations in the participation rates in the National Bowel Cancer Screening Program (NBCSP) are related to population-level socio-demographic characteristics.Methods: Data reflecting participation in the NBCSP for 504 Local Government Areas (LGAs) between July 2011 and June 2013 were extracted from the Social Health Atlas of Australia. Logistic regression models were used to examine independent associations (odds ratios [ORs]) between participation, Remoteness Area (RA) and selected socio-demographic variables.Results: Compared to the participation rate for major cities (33.4%), participation was significantly higher in inner regional areas (36.5%, OR=1.15), but was much lower in remote (27.9%, OR=0.77) or very remote areas (25.0%, OR=0.65). When controlling for study period, gender, proportion of persons aged 65 years and older, Indigenous status, cultural background and socioeconomic status, significantly higher rates were observed in all non-metropolitan areas than in major cities. Indigenous status was strongly related to the poorer participation in remote areas.Conclusions: Socio-demographic characteristics, particularly Indigenous status, cultural background and population ageing, seem to be more important drivers of regional disparities in NBCSP participation than geographic remoteness. Implications for public health:This study provides important evidence to understand the regional disparities in participating in the national screening program.

Geographic Disparities in Previously Diagnosed Health Conditions in Colorectal Cancer Patients Are Largely Explained by Age and Area Level Disadvantage

“…Educational, financial, and social disadvantage can often result in depleted resources for leading a healthy lifestyle and addressing health issues ( 33 – 35 ). Our findings support a growing body of recent evidence suggesting that regional disparity in health may be less about location and more about the characteristics of people within a geographic region ( 36 – 38 ). Recently, health researchers have suggested a shift in focus from broad urban-rural health disparities to understanding the unique characteristics of different communities and the individuals within them ( 36 , 39 , 40 ).…”

Geographic variation in health system performance in rural areas of New South Wales, Australia

“…Although Indigenous status was associated with poorer performance in many of the health system indicators examined, the associations were likely to be due to the socioeconomic disadvantage that is experienced by Indigenous peoples. For example, a previous Australia‐wide study found that lower participation in bowel cancer screening in remote areas was partly related to low uptake by Indigenous Australians, although the results did not hold true for a NSW subgroup analysis 9 . In the current study, remoteness and socioeconomic disadvantage were the strongest predictors of low participation.…”

“…Such an approach masks heterogeneity in rural areas in terms of health status, health care and the social and demographic profile of the population, thereby restricting the tailoring of the provision of services relevant to the needs of the local population. For example, a study of 504 local government areas (LGAs) in Australia found sociodemographic characteristics, particularly Indigenous status, cultural background and population age structure, were more important predictors of geographic disparities in bowel cancer screening participation than remoteness 9 …”

Population-Based Data Reveal Factors Associated with Organised and Non-Organised Colorectal Cancer Screening: An Important Step towards Improving Coverage

“…An interesting result that we found with the use of data at the municipality level is that more men in the screening population were associated with a higher organised screening coverage. This finding seemed counter-intuitive at first sight, since previous studies have shown that women are more likely to participate in CRC screening than men [8,20,23,[29][30][31]. However, a closer data inspection revealed that in Flanders, within a municipality, the screening coverage in women was higher compared to men, but among municipalities, more men in the screening population were associated with a higher screening coverage in both men and women, leading to a higher overall screening coverage.…”