Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/111174
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Type: Journal article
Title: Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in New South Wales, Australia
Author: Tervonen, H.
Aranda, S.
Roder, D.
You, H.
Walton, R.
Morrell, S.
Baker, D.
Currow, D.
Citation: BMC Public Health, 2017; 17(1):691-1-691-11
Publisher: BioMed Central
Issue Date: 2017
ISSN: 1471-2458
1471-2458
Statement of
Responsibility: 
Hanna E. Tervonen, Sanchia Aranda, David Roder, Hui You, Richard Walton, Stephen Morrell, Deborah Baker and David C. Currow
Abstract: Background: Public 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. Methods: Data 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. Results: Increased 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). Conclusions: There 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.
Keywords: Neoplasms; Australia; socioeconomic factors; rural population; cultural diversity; survival analysis
Rights: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
RMID: 0030080860
DOI: 10.1186/s12889-017-4692-y
Grant ID: http://purl.org/au-research/grants/nhmrc/0631946
Appears in Collections:Public Health publications

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