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Geographic remoteness, area-level socioeconomic disadvantage and inequalities in colorectal cancer survival in Queensland: a multilevel analysis

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journal contribution
posted on 2013-10-24, 00:00 authored by Peter D Baade, Paramita Dasgupta, Joanne F Aitken, Gavin Turrell
BACKGROUND: To explore the impact of geographical remoteness and area-level socioeconomic disadvantage on colorectal cancer (CRC) survival. METHODS: Multilevel logistic regression and Markov chain Monte Carlo simulations were used to analyze geographical variations in five-year all-cause and CRC-specific survival across 478 regions in Queensland Australia for 22,727 CRC cases aged 20-84 years diagnosed from 1997-2007. RESULTS: Area-level disadvantage and geographic remoteness were independently associated with CRC survival. After full multivariate adjustment (both levels), patients from remote (odds Ratio [OR]: 1.24, 95%CrI: 1.07-1.42) and more disadvantaged quintiles (OR=1.12, 1.15, 1.20, 1.23 for Quintiles 4, 3, 2 and 1 respectively) had lower CRC-specific survival than major cities and least disadvantaged areas. Similar associations were found for all-cause survival. Area disadvantage accounted for a substantial amount of the all-cause variation between areas. CONCLUSIONS: We have demonstrated that the area-level inequalities in survival of colorectal cancer patients cannot be explained by the measured individual-level characteristics of the patients or their cancer and remain after adjusting for cancer stage. Further research is urgently needed to clarify the factors that underlie the survival differences, including the importance of geographical differences in clinical management of CRC.

History

Journal

BMC cancer

Volume

13

Article number

493

Pagination

1 - 14

Publisher

BioMed Central

Location

London, Eng.

eISSN

1471-2407

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2013, Baade et al.