Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study

BACKGROUND: Reducing disparities in cancer outcomes is a major priority for cancer-control agencies. The authors examine the relationships between geographic remoteness, area disadvantage and risk of advanced breast cancer among women. METHODS: Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced breast cancer among women aged 30-79 years diagnosed as having breast cancer in Queensland, Australia between 1997 and 2006 (n=18,658). RESULTS: Women who resided in the most socio-economically disadvantaged areas were significantly more likely (OR 1.21, 95% CI 1.07 to 1.37) than residents of the most advantaged areas to be diagnosed as having advanced breast cancer after adjustment for individual-level factors. When geographic remoteness and area-disadvantage (and all the individual-level factors) were simultaneously adjusted, the rates of advanced breast cancer were significantly higher for women residing in Outer Regional areas (OR 1.13, 95% CI 1.02 to 1.24) and those who lived in the most disadvantaged areas (OR 1.16, 95% CI 1.02 to 1.32). There was no statistically significant interaction between geographic remoteness and area disadvantage. CONCLUSIONS: A woman's risk of being diagnosed as having advanced breast cancer depends on where she lives, separate from the individual characteristics of the woman herself. Both the rurality and socio-economic characteristics of the geographical area in which women lived were important. The socio-economic factors contributing to advanced breast cancer, existing in both urban and rural environments, need to be investigated.