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Maxwell S, Pearce C, Kynn M, Anderson LA, Weller D, Murchie P. The impact of rurality on patient experience and diagnostic pathway intervals in Scotland's cancer patients: Further results from a national cancer diagnosis audit. Cancer Epidemiol 2023; 86:102414. [PMID: 37499334 DOI: 10.1016/j.canep.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND In Scotland 17 % of the population reside rurally and previous research has demonstrated worse cancer outcomes in this group. The underlying reason for this is unclear. This study aims to determine whether patient presenting factors, GP consultation factors or the diagnostic pathways differ between urban and rural patients within Scotland. METHODS This study combined two Scottish National Cancer Diagnosis Audits. Participating GPs collected data on the diagnostic pathway from primary to secondary care for cancer patients diagnosed during the audit period. Using the Scottish Government Urban Rural Classification, patients were designated as rural or urban dwellers and compared in descriptive analyses. Key cancer intervals (primary, diagnostic, secondary and treatment interval) were compared between urban and rural dwellers with an additional adjusted analysis for the main cancer sites. RESULTS A total of 4309 cancer diagnoses were included in the study; 22 % were in patients from rural locations. Rural patients had significantly more consultations and investigations prior to referral than their urban counterparts. There was no difference in prolonged cancer pathways between the two groups except in lung cancer patients where rural patients had a significantly increased odds of a diagnostic interval of >90 days. CONCLUSION Our findings suggest differences in the interaction between patients and GPs prior to referral in urban and rural settings. However, this does not appear to lead to prolonged patient pathways, except in lung cancer. Further research is needed to determine whether this delay is clinically significant and contributing to poorer outcomes in Scottish rural dwellers with lung cancer.
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Affiliation(s)
- Susanne Maxwell
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Clara Pearce
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - Mary Kynn
- Faculty of Science and Engineering, Curtin University, Kent Street, Bentley WA 6102, Australia
| | - Lesley Ann Anderson
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom
| | - David Weller
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, United Kingdom.
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2
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Tham NL, Skandarajah A, Hayes IP. Socioeconomic disadvantage and its impact on colorectal cancer in Australia: a scoping review. ANZ J Surg 2022; 92:2808-2815. [PMID: 36189982 PMCID: PMC9828090 DOI: 10.1111/ans.18081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation. METHODS A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made. RESULTS Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area-level measures were commonly used to assess socioeconomic status, with varying indices utilized. CONCLUSION There is limited evidence that socioeconomic status is associated with late-stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically-detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival.
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Affiliation(s)
- Nicole Li Tham
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Anita Skandarajah
- Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
| | - Ian Paul Hayes
- Colorectal Surgical UnitThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of General Surgical SpecialtiesThe Royal Melbourne HospitalParkvilleVictoriaAustralia,Department of SurgeryThe University of MelbourneMelbourneVictoriaAustralia
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Fayet Y, Chevreau C, Decanter G, Dalban C, Meeus P, Carrère S, Haddag-Miliani L, Le Loarer F, Causeret S, Orbach D, Kind M, Le Nail LR, Ferron G, Labrosse H, Chaigneau L, Bertucci F, Ruzic JC, Le Brun Ly V, Farsi F, Bompas E, Noal S, Vozy A, Ducoulombier A, Bonnet C, Chabaud S, Ducimetière F, Tlemsani C, Ropars M, Collard O, Michelin P, Gantzer J, Dubray-Longeras P, Rios M, Soibinet P, Le Cesne A, Duffaud F, Karanian M, Gouin F, Tétreau R, Honoré C, Coindre JM, Ray-Coquard I, Bonvalot S, Blay JY. No Geographical Inequalities in Survival for Sarcoma Patients in France: A Reference Networks' Outcome? Cancers (Basel) 2022; 14:cancers14112620. [PMID: 35681600 PMCID: PMC9179906 DOI: 10.3390/cancers14112620] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/15/2022] [Accepted: 05/23/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary As patients with rare cancers face specific problems, reference networks have been developed in several European countries and then at the European level to improve their management. In some cases, the specialized centers belonging to reference networks provide remote services (specialized diagnosis review, discussion in the Multidisciplinary Tumour Board, etc.) to increase access to these services. Using data from the national sarcoma reference network implemented in France (NETSARC+), the IGéAS research program assesses the potential of its organization to address the geographical inequalities in cancer management. We analyze the individual, clinical, and geographical determinants of the overall survival of sarcoma patients in France. We found no association between the overall survival of sarcoma patients and variables measuring their social deprivation, remoteness from reference centers, and geographical context. Following previous results from the research program, this study suggests that reference network organization should be considered to reduce cancer inequalities. Abstract The national reference network NETSARC+ provides remote access to specialized diagnosis and the Multidisciplinary Tumour Board (MTB) to improve the management and survival of sarcoma patients in France. The IGéAS research program aims to assess the potential of this innovative organization to address geographical inequalities in cancer management. Using the IGéAS cohort built from the nationwide NETSARC+ database, the individual, clinical, and geographical determinants of the 3-year overall survival of sarcoma patients in France were analyzed. The survival analysis was focused on patients diagnosed in 2013 (n = 2281) to ensure sufficient hindsight to collect patient follow-up. Our study included patients with bone (16.8%), soft-tissue (69%), and visceral (14.2%) sarcomas, with a median age of 61.8 years. The overall survival was not associated with geographical variables after adjustment for individual and clinical factors. The lower survival in precarious population districts [HR 1.23, 95% CI 1.02 to 1.48] in comparison to wealthy metropolitan areas (HR = 1) found in univariable analysis was due to the worst clinical presentation at diagnosis of patients. The place of residence had no impact on sarcoma patients’ survival, in the context of the national organization driven by the reference network. Following previous findings, this suggests the ability of this organization to go through geographical barriers usually impeding the optimal management of cancer patients.
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Affiliation(s)
- Yohan Fayet
- EMS Team–Human and Social Sciences Department, Centre Léon Bérard, 69008 Lyon, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, 69008 Lyon, France
- Correspondence:
| | | | - Gauthier Decanter
- Department of Surgical Oncology, Oscar Lambret Center, 59000 Lille, France;
| | - Cécile Dalban
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | - Pierre Meeus
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Sébastien Carrère
- Institut de Recherche en Cancérologie Montpellier, INSERM U1194, 34000 Montpellier, France;
| | - Leila Haddag-Miliani
- Service D’imagerie Diagnostique, Institut Gustave Roussy, 94800 Villejuif, France;
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Daniel Orbach
- Centre Oncologie SIREDO (Soins, Innovation et Recherche en Oncologie de l’Enfant, de l’aDOlescents et de L’adulte Jeune), Institut Curie, Université de Recherche Paris Sciences et Lettres, 75005 Paris, France;
| | - Michelle Kind
- Radiologue, Département D’imagerie Médicale, Institut Bergonié, 33000 Bordeaux, France;
| | - Louis-Romée Le Nail
- Department of Orthopaedic Surgery, CHU de Tours, Faculté de Médecine, Université de Tours, 37000 Tours, France;
| | - Gwenaël Ferron
- INSERM CRCT19 ONCO-SARC (Sarcoma Oncogenesis), Institut Claudius Regaud-Institut Universitaire du Cancer, 31000 Toulouse, France;
| | - Hélène Labrosse
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | - Loïc Chaigneau
- Department of Medical Oncology, CHRU Jean Minjoz, 25000 Besançon, France;
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, 13009 Marseille, France;
| | | | | | - Fadila Farsi
- CRLCC Léon Berard, Oncology Regional Network ONCO-AURA, 69008 Lyon, France; (H.L.); (F.F.)
| | | | - Sabine Noal
- UCP Sarcome, Centre François Baclesse, 14000 Caen, France;
| | - Aurore Vozy
- Department of Medical Oncology, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), CLIP(2) Galilée, Sorbonne University, 75013 Paris, France;
| | | | - Clément Bonnet
- Service d’Oncologie Médicale Hôpital Saint Louis, 75010 Paris, France;
| | - Sylvie Chabaud
- Department of Clinical Research and Innovation, Centre Léon Bérard, 69008 Lyon, France; (C.D.); (S.C.)
| | | | - Camille Tlemsani
- Service d’Oncologie Médicale, Hôpital Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France;
- INSERM U1016-CNRS UMR8104, Institut Cochin, Institut du Cancer Paris CARPEM, Université de Paris, APHP Centre, 75014 Paris, France
| | - Mickaël Ropars
- Orthopaedic and Trauma Department, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France;
| | - Olivier Collard
- Département d’Oncologie Médicale, Hôpital Privé de la Loire, 42100 Saint-Etienne, France;
| | - Paul Michelin
- Service D’imagerie Médicale, CHU Hopitaux de Rouen-Hopital Charles Nicolle, 76000 Rouen, France;
| | - Justine Gantzer
- Department of Medical Oncology, Strasbourg-Europe Cancer Institute (ICANS), 67033 Strasbourg, France;
| | | | - Maria Rios
- Department of Medical Oncology, Cancer Institute of Lorraine-Alexis Vautrin, 54500 Vandoeuvre Les Nancy, France;
| | - Pauline Soibinet
- Department of Hepato-Gastroenterology and Digestive Oncology, Reims University Hospital, 51000 Reims, France;
| | - Axel Le Cesne
- Medical Oncology, Insitut Gustave Roussy, 94800 Villejuif, France;
| | - Florence Duffaud
- Department of Medical Oncology, CHU La Timone and Aix-Marseille Université (AMU), 13005 Marseille, France;
| | - Marie Karanian
- Department of Pathology, Lyon University Hospital, 69008 Lyon, France;
| | - François Gouin
- Department of Surgery, Centre Léon Bérard, 69008 Lyon, France; (P.M.); (F.G.)
| | - Raphaël Tétreau
- Medical Imaging Center, Institut du Cancer, 34000 Montpellier, France;
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy, Villejuif 94800, France;
| | - Jean-Michel Coindre
- Department of Pathology, Institut Bergonié, 33000 Bordeaux, France; (F.L.L.); (J.-M.C.)
| | | | - Sylvie Bonvalot
- Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, 75005 Paris, France;
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon University, 69008 Lyon, France;
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Ingleby FC, Woods LM, Atherton IM, Baker M, Elliss-Brookes L, Belot A. An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales. BMC Public Health 2022; 22:90. [PMID: 35027042 PMCID: PMC8759193 DOI: 10.1186/s12889-022-12525-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/06/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation. METHODS Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20-99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects. RESULTS For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing "degree-level qualification and higher" to "no qualification" and EHR = 0.74 [0.56;0.97] comparing "apprenticeships and vocational qualification" to "no qualification", adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing "managerial/professional occupations" to "manual/technical," and EHR = 0.81 [0.63;1.06] comparing "intermediate" to "manual/technical", adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects. CONCLUSIONS Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice.
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Affiliation(s)
- Fiona C Ingleby
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Laura M Woods
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Iain M Atherton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Matthew Baker
- National Cancer Research Institute Consumer Forum, London, UK
| | - Lucy Elliss-Brookes
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - Aurélien Belot
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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White VM, Lisy K, Ward A, Ristevski E, Clode M, Webber K, Emery J, Ijzerman MJ, Afshar N, Millar J, Gibbs P, Evans S, Jefford M. Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors. Support Care Cancer 2022; 30:5299-5309. [PMID: 35279769 PMCID: PMC9046289 DOI: 10.1007/s00520-022-06914-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To examine how socio-demographic, comorbidities and information needs influence quality of life (QoL) outcomes of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma. METHODS Cross-sectional postal survey with eligible participants identified through a population-based cancer registry. QoL outcomes were assessed by EQ-5D-5L, social difficulties index (SDI) and, for those employed at diagnosis, current employment. Regression analyses explored associations between outcome variables and cancer type, age, time since diagnosis, residential location, socio-economic disadvantage, comorbidities and unmet information needs. Mediation analyses examined whether comorbidities and information needs explained relationships between outcome variables and socio-economic disadvantage. RESULTS 2115 survivors participated. Mean EQ-5D-5L scores (mean = 0.84) were similar to population averages and SDI scores were low for the entire sample (mean = 3.80). In multivariate analyses, being aged over 80, greater socio-economic disadvantage, comorbidities and unmet information needs decreased EQ-5D-5L scores. Higher SDI scores were associated with socio-economic disadvantage, comorbidities and unmet information needs. Not being employed was associated with being aged over 50, more comorbidities and socio-economic disadvantage. Comorbidities but not information needs partially mediated the impact of socio-economic disadvantage on EQ-5D-5L and SDI accounting for 17% and 14% of the total effect of socio-economic disadvantage respectively. Neither comorbidities nor information needs mediated the association between socio-economic disadvantage and employment outcomes. CONCLUSIONS To improve quality of life, survivorship care should be better tailored to address the needs of individuals given their overall health and impact of comorbidities, their age and type of cancer and not simply time since diagnosis.
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Affiliation(s)
- Victoria M. White
- grid.1021.20000 0001 0526 7079School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia ,grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia
| | - Karolina Lisy
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Andrew Ward
- The Social Research Centre, Melbourne, VIC Australia
| | - Eli Ristevski
- grid.1002.30000 0004 1936 7857Monash Rural Health, Monash University, Warragul, VIC Australia
| | - Melanie Clode
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Kate Webber
- grid.1002.30000 0004 1936 7857School of Clinical Sciences, Monash University, Clayton, VIC Australia ,grid.419789.a0000 0000 9295 3933Department of Oncology, Monash Health, Clayton, VIC Australia
| | - Jon Emery
- grid.1008.90000 0001 2179 088XDepartment of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - Maarten J. Ijzerman
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
| | - Nina Afshar
- grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XCentre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jeremy Millar
- grid.267362.40000 0004 0432 5259Alfred Health Radiation Oncology, Alfred and LaTrobe Regional Hospital, Melbourne, VIC 3004 Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Health, St. Albans, Victoria, Australia ,grid.1042.70000 0004 0432 4889Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC Australia
| | - Sue Evans
- grid.3263.40000 0001 1482 3639Cancer Council Victoria, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Michael Jefford
- grid.1055.10000000403978434Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC Australia
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Thatcher EJ, Camacho F, Anderson RT, Li L, Cohn WF, DeGuzman PB, Porter KJ, Zoellner JM. Spatial analysis of colorectal cancer outcomes and socioeconomic factors in Virginia. BMC Public Health 2021; 21:1908. [PMID: 34674672 PMCID: PMC8529747 DOI: 10.1186/s12889-021-11875-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/28/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities. METHODS County- and city-level cross-sectional data for 2011-2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression. RESULTS For incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region. CONCLUSIONS Rurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.
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Affiliation(s)
| | - Fabian Camacho
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | - Roger T. Anderson
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | - Li Li
- Department of Family Medicine, School of Medicine, University of Virginia, Charlottesville, USA
| | - Wendy F. Cohn
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | | | - Kathleen J. Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
| | - Jamie M. Zoellner
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, USA
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7
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Afshar N, Dashti SG, Te Marvelde L, Blakely T, Haydon A, White VM, Emery JD, Bergin RJ, Whitfield K, Thomas RJS, Giles GG, Milne RL, English DR. Factors Explaining Socio-Economic Inequalities in Survival from Colon Cancer: A Causal Mediation Analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:1807-1815. [PMID: 34272266 DOI: 10.1158/1055-9965.epi-21-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/09/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Socio-economic inequalities in colon cancer survival exist in high-income countries, but the reasons are unclear. We assessed the mediating effects of stage at diagnosis, comorbidities, and treatment (surgery and intravenous chemotherapy) on survival from colon cancer. METHODS We identified 2,203 people aged 15 to 79 years with first primary colon cancer diagnosed in Victoria, Australia, between 2008 and 2011. Colon cancer cases were identified through the Victorian Cancer Registry (VCR), and clinical information was obtained from hospital records. Deaths till December 31, 2016 (n = 807), were identified from Victorian and national death registries. Socio-economic disadvantage was based on residential address at diagnosis. For stage III disease, we decomposed its total effect into direct and indirect effects using interventional mediation analysis. RESULTS Socio-economic inequalities in colon cancer survival were not explained by stage and were greater for men than women. For men with stage III disease, there were 161 [95% confidence interval (CI), 67-256] additional deaths per 1,000 cases in the 5 years following diagnosis for the most disadvantaged compared with the least disadvantaged. The indirect effects through comorbidities and intravenous chemotherapy explained 6 (95% CI, -10-21) and 15 (95% CI, -14-44) per 1,000 of these additional deaths, respectively. Surgery did not explain the observed gap in survival. CONCLUSIONS Disadvantaged men have lower survival from stage III colon cancer that is only modestly explained by having comorbidities or not receiving chemotherapy after surgery. IMPACT Future studies should investigate the potential mediating role of factors occurring beyond the first year following diagnosis, such as compliance with surveillance for recurrence and supportive care services.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
- Cancer Health Services Research Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - S Ghazaleh Dashti
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Luc Te Marvelde
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Department of Medical Oncology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Victoria M White
- School of Psychology, Deakin University, Burwood, Victoria, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Jon D Emery
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Rebecca J Bergin
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Cancer in Primary Care Research Group, Department of General Practice, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert J S Thomas
- Cancer Strategy and Development, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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8
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Pasch JA, MacDermid E, Velovski S. Effect of rurality and socioeconomic deprivation on presentation stage and long-term outcomes in patients undergoing surgery for colorectal cancer. ANZ J Surg 2021; 91:1569-1574. [PMID: 33792127 DOI: 10.1111/ans.16734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Geographical remoteness and socioeconomic status (SES) are important factors affecting presentation stage and survival for colorectal cancer. A series of patients from a single institution in northern New South Wales was studied to determine if rural isolation or SES affected presentation and survival in patients undergoing resection. METHODS Consecutive colorectal cancer resections performed at Lismore Base Hospital from 2011 to 2019 were identified. Patient residential addresses were categorized by the Modified Monash Model (MMM), an Australian Government definition of rural isolation, and Socioeconomic Index for Areas (SEIFA) quintiles, an Australian Bureau of Statistics index of socioeconomic deprivation. Univariate and Cox regression survival analysis was performed on data from histopathology and clinical notes matched with survival data. RESULTS A total of 405 patients were included in MMM categories 3 (n = 207, 51.1%), 4 (n = 69, 17%) and 5 (n = 129, 31.9) corresponding to large, medium and small rural towns. MMM 3 was associated with emergency cases (25.6% versus 18.7%, P < 0.001), nodal disease (44.4% versus 38.4%, P = 0.018) and T3/4 tumours (82.1% versus 73.7%, P < 0.001) compared with isolated patients without difference in 5-year survival (P = 0.370). Disadvantaged SEIFA quintiles 1/2 demonstrated increased poor differentiation (23.0% versus 15.4%, P < 0.001) and vascular invasion (15.8% versus 9.1%, P < 0.001) with reduced 5-year survival (57.0% versus 70.4%, P = 0.039). Independent predictors of survival included age, emergency cases, group stage, lymphatic invasion and low lymph node yield. CONCLUSION A 'rural reversal' may be present for patients in northern New South Wales; however, SES and established clinicopathological factors are the strongest predictors of survival in our population.
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Affiliation(s)
- James A Pasch
- Department of Surgery, Northern Beaches Hospital, Sydney, New South Wales, Australia
| | - Ewan MacDermid
- Department of Colorectal Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Susan Velovski
- Department of Surgery, Lismore Base Hospital, Lismore, New South Wales, Australia
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9
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Spatial Variation of Survival for Colorectal Cancer in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031052. [PMID: 33503972 PMCID: PMC7908469 DOI: 10.3390/ijerph18031052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
A patient's survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients' central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services.
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10
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Golledge J, Drovandi A, Velu R, Quigley F, Moxon J. Survival following abdominal aortic aneurysm repair in North Queensland is not associated with remoteness of place of residence. PLoS One 2020; 15:e0241802. [PMID: 33186377 PMCID: PMC7665769 DOI: 10.1371/journal.pone.0241802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To assess whether survival and clinical events following elective abdominal aortic aneurysm (AAA) repair were associated with remoteness of residence in North Queensland, Australia. Methods This retrospective cohort study included participants undergoing elective AAA repair between February 2002 and April 2020 at two hospitals in Townsville, North Queensland, Australia. Outcomes were all-cause survival and AAA-related events, defined as requirement for repeat AAA repair or AAA-related mortality. Remoteness of participant’s place of residence was assessed by the Modified Monash Model classifications and estimated distance from the participants’ home to the tertiary vascular centre. Cox proportional hazard analysis examined the association of remoteness with outcome. Results The study included 526 participants undergoing elective repair by open (n = 204) or endovascular (n = 322) surgery. Fifty-four (10.2%) participants had a place of residence at a remote or very remote location. Participants' were followed for a median of 5.2 (inter-quartile range 2.5–8.3) years, during which time there were 252 (47.9%) deaths. Survival was not associated with either measure of remoteness. Fifty (9.5%) participants had at least one AAA-related event, including 30 (5.7%) that underwent at least one repeat AAA surgery and 23 (4.4%) that had AAA-related mortality. AAA-related events were more common in participants resident in the most remote areas (adjusted hazard ratio 2.83, 95% confidence intervals 1.40, 5.70) but not associated with distance from the participants’ residence to the tertiary vascular centre Conclusions The current study found that participants living in more remote locations were more likely to have AAA-related events but had no increased mortality following AAA surgery. The findings emphasize the need for careful follow-up after AAA surgery. Further studies are needed to examine the generalisability of the findings.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
- * E-mail:
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
| | - Ramesh Velu
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia
| | - Frank Quigley
- Mater Private Hospital, Townsville, Queensland, Australia
| | - Joseph Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Australian Institute of Tropical Medicine, James Cook University, Townsville, Queensland, Australia
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11
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Kou K, Dasgupta P, Aitken JF, Baade PD. Impact of area-level socioeconomic status and accessibility to treatment on life expectancy after a cancer diagnosis in Queensland, Australia. Cancer Epidemiol 2020; 69:101803. [PMID: 32927295 DOI: 10.1016/j.canep.2020.101803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
AIMS This study quantifies geographic inequities in loss of life expectancy (LOLE) by area-level socioeconomic status (SES) and accessibility to treatment. METHODS Analysis was conducted using a population-based cancer-registry cohort (n = 371,570) of Queensland (Australia) residents aged 50-89 years, diagnosed between 1997-2016. Flexible parametric survival models were used to estimate LOLE by area-level SES and accessibility for all invasive cancers and the five leading cancers. The gain in life years that could be achieved if all cancer patients experienced the same relative survival as those in the least disadvantaged-high accessibility category was estimated for the 2016 cohort. RESULTS For all invasive cancers, men living in the most disadvantaged areas lost 34 % of life expectancy due to their cancer diagnosis, while those from the least disadvantaged areas lost 25 %. The corresponding percentages for women were 33 % and 23 %. Accessibility had a lower impact on LOLE than SES, with patients from low accessibility areas losing 0-4 % more life expectancy than those from high accessibility areas. For cancer patients diagnosed in 2016 (n = 24,423), an estimated 101,387 life years will be lost. This would be reduced by 19 % if all patients experienced the same relative survival as those from the least disadvantaged-high accessibility areas. CONCLUSION The impact of a cancer diagnosis on remaining life expectancy varies by geographical area. Establishing reasons why area disadvantage impacts on life expectancy is crucial to inform subsequent interventions that could increase the life expectancy of cancer patients from more disadvantaged areas.
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Affiliation(s)
- Kou Kou
- Cancer Council Queensland, Brisbane, Australia
| | | | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD 4222, Australia; School of Mathematical Sciences, Queensland University of Technology, Gardens Point, Brisbane, QLD 4000, Australia.
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12
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Afshar N, English DR, Chamberlain JA, Blakely T, Thursfield V, Farrugia H, Giles GG, Milne RL. Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry. Cancer Causes Control 2020; 31:617-629. [PMID: 32356140 DOI: 10.1007/s10552-020-01303-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/15/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia. METHODS Incident cancer cases diagnosed in 2001-2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar-Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated. RESULTS People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney. CONCLUSION People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia.
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - James A Chamberlain
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tony Blakely
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
| | - Vicky Thursfield
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Helen Farrugia
- Victorian Cancer Registry, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3010, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
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13
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Goodwin BC, Rowe AK, Crawford-Williams F, Baade P, Chambers SK, Ralph N, Aitken JF. Geographical Disparities in Screening and Cancer-Related Health Behaviour. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041246. [PMID: 32075173 PMCID: PMC7068477 DOI: 10.3390/ijerph17041246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/11/2023]
Abstract
This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014-2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.
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Affiliation(s)
- Belinda C. Goodwin
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Correspondence:
| | - Arlen K. Rowe
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- School of Psychology, University of Southern Queensland, Springfield QLD 4300, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
| | - Peter Baade
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Menzies Institute of Health Queensland, Griffith University, Gold Coast QLD 4215, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane QLD 4000, Australia
| | - Suzanne K. Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Menzies Institute of Health Queensland, Griffith University, Gold Coast QLD 4215, Australia
- Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup WA 6027, Australia
| | - Nicholas Ralph
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- Faculty of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
- School of Nursing & Midwifery, University of Southern Queensland, Toowoomba QLD 4370, Australia
| | - Joanne F. Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley QLD 4006, Australia; (P.B.); (N.R.); (J.F.A.)
- Institute for Resilient Regions, University of Southern Queensland, Springfield QLD 4300, Australia; (A.K.R.); (F.C.-W.); (S.K.C.)
- School of Public Health, The University of Queensland, St Lucia, QLD 4702, Australia
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14
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Theile DE, Philpot S, Blake M, Harrington J, Youl PH. Outcomes following colorectal cancer surgery: Results from a population-based study in Queensland, Australia, using quality indicators. J Eval Clin Pract 2019; 25:834-842. [PMID: 30575221 DOI: 10.1111/jep.13087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Colorectal cancer (CRC) is one of the most common cancers diagnosed worldwide, and rates are continuing to rise. Surgery is the primary treatment for CRC, and our aim was to examine clinical outcomes following major resection using a series of established quality indicators and to identify factors associated with poor clinical outcomes. METHOD This population-based retrospective study included 4321 patients with diagnosed with CRC in 2012 and 2014 in Queensland, Australia, who underwent a major resection. Primary outcomes included in-hospital mortality, 30-day unplanned readmission, extended hospital stay (>21 days), and 30- and 90-day mortality. Multivariable logistic regression modelling was conducted to establish factors independently associated with each outcome of interest. RESULTS Overall, in-hospital mortality was 1.5%, 3.0% had an unplanned readmission, 8% had an extended hospital stay, and 30- and 90-day postoperative mortality was 1.6% and 3.1%, respectively. After adjustment, we found that factors such as older age, presence of comorbidities, emergency admission, and stoma formation were significantly associated with poorer outcomes with these findings being consistent across each of the outcomes of interest. In addition to these factors, the risk of 90-day mortality was significantly elevated for patients with advanced stage disease (OR = 1.95, CI 1.35-2.82). Sex, primary site, hospital volume, residential location, nor socioeconomic status was found to be associated with any of the outcomes of interest. CONCLUSION Overall, the risk of poorer clinical outcomes for CRC patients in Queensland, Australia, is low. There is however a subgroup of patients at particularly elevated risk of poorer outcomes following CRC. Strategies to reduce the poorer clinical outcomes this group of patients experience should be explored.
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Affiliation(s)
- David E Theile
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Brisbane, Australia
| | - Shoni Philpot
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Brisbane, Australia
| | - Michael Blake
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Brisbane, Australia
| | - John Harrington
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Brisbane, Australia
| | - Philippa H Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Brisbane, Australia
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15
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Kou K, Baade PD, Gatton M, Cramb SM, Sun J, Lu Z, Fu Z, Chu J, Xu A, Guo X. Individual- and Area-Level Socioeconomic Inequalities in Esophageal Cancer Survival in Shandong Province, China: A Multilevel Analysis. Cancer Epidemiol Biomarkers Prev 2019; 28:1427-1434. [PMID: 31239265 DOI: 10.1158/1055-9965.epi-19-0203] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/02/2019] [Accepted: 06/21/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND China contributes to almost half of the esophageal cancer cases diagnosed globally each year. However, the prognosis information of this disease in this large population is scarce. METHODS Data on a population-based cohort consisting of residents of Shandong Province, China who were diagnosed with esophageal cancer during the period from 2005 to 2014 were analyzed. The cancer-specific survival rates were estimated using Kaplan-Meier analysis. Discrete-time multilevel mixed-effects survival models were used to investigate socioeconomic status (SES) disparities on esophageal cancer survival. RESULTS The unadjusted 1-, 3-, and 5-year cause-specific survival rates were 59.6% [95% confidence interval (CI), 59.2%-59.9%], 31.9% (95% CI, 31.5%-32.3%), and 23.6% (95% CI, 23.1%-24.0%), respectively. Patients of blue-collar occupations had higher risk of esophageal cancer-related death than those of white-collar occupations in the first 2 years after diagnosis. Rural patients had higher risk of death than urban patients in the first 3 years after diagnosis. The risks of esophageal cancer-related death among patients living in low/middle/high SES index counties were not different in the first 2 years after diagnosis. However, patients living in high SES index counties had better long-term survival (3-5 years postdiagnosis) than those living in middle or low SES index counties. CONCLUSIONS Socioeconomic inequalities in esophageal cancer survival exist in this Chinese population. Higher individual- or area-level SES is associated with better short-term or long-term cancer survival. IMPACT Elucidation of the relative roles of the SES factors on survival could guide interventions to reduce disparities in the prognosis of esophageal cancer.
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Affiliation(s)
- Kou Kou
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Michelle Gatton
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Jiandong Sun
- Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Zilong Lu
- Shandong Centre for Disease Control and Prevention, Jinan, China
| | - Zhentao Fu
- Shandong Centre for Disease Control and Prevention, Jinan, China
| | - Jie Chu
- Shandong Centre for Disease Control and Prevention, Jinan, China
| | - Aiqiang Xu
- Shandong Centre for Disease Control and Prevention, Jinan, China
| | - Xiaolei Guo
- Shandong Centre for Disease Control and Prevention, Jinan, China.
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16
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Pule ML, Buckley E, Niyonsenga T, Roder D. The effects of comorbidity on colorectal cancer mortality in an Australian cancer population. Sci Rep 2019; 9:8580. [PMID: 31189947 PMCID: PMC6561932 DOI: 10.1038/s41598-019-44969-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/29/2019] [Indexed: 01/18/2023] Open
Abstract
This study estimated the absolute risk of colorectal cancer (CRC) specific and other-cause mortality using data from the population-based South Australian Cancer Registry. The impact of competing risks on the absolute and relative risks of mortality in cases with and without comorbidity was also investigated. The study included 7115 staged, primary CRC cases diagnosed between 2003 and 2012 with at least one year of follow-up. Comorbidities were classified according to Charlson, Elixhauser and C3 comorbidity indices, using hospital inpatient diagnoses occurring five years before CRC diagnosis. To estimate the differences in measures of association, the subdistribution hazard ratios (sHR) for the effect of comorbidity on mortality from the Fine and Gray model were compared to the cause-specific hazards (HR) from Cox regression model. CRC was most commonly diagnosed in people aged ≧ 70 years. In cases without comorbidity, the 10-year cumulative probability of CRC and other cause mortality were 37.1% and 17.2% respectively. In cases with Charlson comorbidity scores ≥2, the 10-year cumulative probability of CRC-specific and other cause mortality was 45.5% and 32.2%, respectively. Comorbidity was associated with increased CRC-specific and other cause mortality and the effect differed only marginally based on comorbidity index used.
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Affiliation(s)
- Maleshwane Lettie Pule
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia.
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
| | - Theophile Niyonsenga
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
- Centre for Research and Action in Public Health, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
| | - David Roder
- Cancer Epidemiology and Population Health Group, University of South Australia Cancer Research Institute, Adelaide, SA, 5001, Australia
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17
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Valery PC, Bernardes CM, de Witt A, Martin J, Walpole E, Garvey G, Williamson D, Meiklejohn J, Hartel G, Ratnasekera IU, Bailie R. Are general practitioners getting the information they need from hospitals and specialists to provide quality cancer care for Indigenous Australians? Intern Med J 2019; 50:38-47. [PMID: 31081226 DOI: 10.1111/imj.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer care involves many different healthcare providers. Delayed or inaccurate communication between specialists and general practitioners (GP) may negatively affect care. AIM To describe the pattern and variation of communication between primary healthcare (PHC) services and hospitals and specialists in relation to the patient's cancer care. METHODS A retrospective audit of clinical records of Indigenous Australians diagnosed with cancer during 2010-2016 identified through 10 PHC services in Queensland is described. Poisson regression was used to model the dichotomous outcome availability of hospital discharge summary versus not. RESULTS A total of 138 patient records was audited; 115 of those patients visited the PHC service for cancer-related care after cancer diagnosis; 40.0% visited the service before a discharge summary was available, and 36.5% of the patients had no discharge summary in their medical notes. While most discharge summaries noted important information about the patient's cancer, 42.4% lacked details regarding the discharge medications regimen. CONCLUSIONS Deficits in communication and information transfer between specialists and GP may adversely affect patient care. Indigenous Australians are a relatively disadvantaged group that experience poor health outcomes and relatively poor access to care. The low proportion of discharge summaries noting discharge medication regimen is of concern among Indigenous Australians with cancer who have high comorbidity burden and low health literacy. Our findings provide an insight into some of the factors associated with quality of cancer care, and may provide guidance for focus areas for further research and improvement efforts.
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Affiliation(s)
- Patricia C Valery
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Christina M Bernardes
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Audra de Witt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Health, Translational Research Institute, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jennifer Martin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Euan Walpole
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Daniel Williamson
- Aboriginal and Torres Strait Islander Health Unit, Queensland Health, Brisbane, Queensland, Australia
| | | | - Gunter Hartel
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Isanka U Ratnasekera
- Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Ross Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
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Crawford-Williams F, March S, Goodwin BC, Ireland MJ, Chambers SK, Aitken JF, Dunn J. Geographic variations in stage at diagnosis and survival for colorectal cancer in Australia: A systematic review. Eur J Cancer Care (Engl) 2019; 28:e13072. [PMID: 31056787 DOI: 10.1111/ecc.13072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Australia has one of the highest incidence rates of colorectal cancer (CRC) in the world. Residents in rural areas of Australia experience disadvantage in health care and outcomes. This review investigates whether patients with CRC in rural areas demonstrate poorer survival and more advanced stages of disease at diagnosis. METHODS Systematic review of peer-reviewed articles and grey literature. Studies were included if they provided data on survival or stage of disease at diagnosis across multiple geographical locations; focused on CRC patients; and were conducted in Australia. RESULTS Twenty-six articles met inclusion criteria. Twenty-three studies examined survival, while five studies investigated stage at diagnosis. The evidence suggests that non-metropolitan patients are less likely to survive CRC for five years compared to patients living in metropolitan areas, yet there was limited evidence to suggest geographical disparity in stage of diagnosis. CONCLUSIONS While five-year survival disparities are apparent, these patterns appear to vary as a function of specific region and health jurisdiction, cancer type and year/s of data collection. Future research should examine current data using consistent and robust methods of reporting survival and classifying geographical location. The impact of population-level screening programmes on survival and stage at diagnosis also needs to be thoroughly explored.
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Affiliation(s)
- Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,School of Psychology, University of Southern Queensland, Springfield Central, Queensland, Australia
| | - Suzanne K Chambers
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanne F Aitken
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
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19
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Patterns of primary health care service use of Indigenous Australians diagnosed with cancer. Support Care Cancer 2019; 28:317-327. [DOI: 10.1007/s00520-019-04821-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/16/2019] [Indexed: 12/19/2022]
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20
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Afshar N, English DR, Milne RL. Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer 2019; 125:2172-2184. [PMID: 30933318 DOI: 10.1002/cncr.32073] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 12/21/2022]
Abstract
There is some evidence that place of residence is associated with cancer survival, but the findings are inconsistent, and the underlying mechanisms by which residential location might affect survival are not well understood. We conducted a systematic review of observational studies investigating the association of rural versus urban residence with cancer survival in high-income countries. We searched the Ovid Medline, EMBASE, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases up to May 31, 2016. Forty-five studies published between 1984 and 2016 were included. We extracted unadjusted and adjusted relative risk estimates with the corresponding 95% confidence intervals. Most studies reported worse survival for cancer patients living in rural areas than those in urban regions. The most consistent evidence, observed across several studies, was for colorectal, lung, and prostate cancer. Of the included studies, 18 did not account for socio-economic position. Lower survival for more disadvantaged patients is well documented; therefore, it could be beneficial for future research to take socio-economic factors into consideration when assessing rural/urban differences in cancer survival. Some studies cited differential stage at diagnosis and treatment modalities as major contributing factors to regional inequalities in cancer survival. Further research is needed to disentangle the mediating effects of these factors, which may help to establish effective interventions to improve survival for patients living outside major cities.
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Affiliation(s)
- Nina Afshar
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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21
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Kuo TM, Meyer AM, Baggett CD, Olshan AF. Examining determinants of geographic variation in colorectal cancer mortality in North Carolina: A spatial analysis approach. Cancer Epidemiol 2019; 59:8-14. [PMID: 30640041 DOI: 10.1016/j.canep.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/16/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE A recent study using national data from 2000 to 2009 identified colorectal cancer (CRC) mortality "hotspots" in 11 counties of North Carolina (NC). In this study, we used more recent, state-specific data to investigate the county-level determinants of geographic variation in NC through a geospatial analytic approach. METHOD Using NC CRC mortality data from 2003 to 2013, we first conducted clustering analysis to confirm spatial dependence. Spatial economic models were then used to incorporate spatial structure to estimate the association between determinants and CRC mortality. We included county-level data on socio-demographic characteristics, access and quality of healthcare, behavioral risk factors (CRC screening, obesity, and cigarette smoking), and urbanicity. Due to correlation among screening, obesity and quality of healthcare, we combined these factors to form a cumulative risk group variable in the analysis. RESULTS We confirmed the existence of spatial dependence and identified clusters of elevated CRC mortality rates in NC counties. Using a spatial lag model, we found significant interaction effect between CRC risk groups and socioeconomic deprivation. Higher CRC mortality rates were also associated with rural counties with large towns compared to urban counties. CONCLUSION Our findings depicted a spatial diffusion process of CRC mortality rates across NC counties, demonstrated intertwined effects between SES deprivation and behavioral risks in shaping CRC mortality at area-level, and identified counties with high CRC mortality that were also deprived in multiple factors. These results suggest interventions to reduce geographic variation in CRC mortality should develop multifaceted strategies and work through shared resources in neighboring areas.
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Affiliation(s)
- Tzy-Mey Kuo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Anne Marie Meyer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher D Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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22
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Goodwin BC, March S, Ireland MJ, Crawford-Williams F, Ng SK, Baade PD, Chambers SK, Aitken JF, Dunn J. Geographic Disparities in Previously Diagnosed Health Conditions in Colorectal Cancer Patients Are Largely Explained by Age and Area Level Disadvantage. Front Oncol 2018; 8:372. [PMID: 30254984 PMCID: PMC6141831 DOI: 10.3389/fonc.2018.00372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Geographical disparity in colorectal cancer (CRC) survival rates may be partly due to aging populations and disadvantage in more remote locations; factors that also impact the incidence and outcomes of other chronic health conditions. The current study investigates whether geographic disparity exists amongst previously diagnosed health conditions in CRC patients above and beyond age and area-level disadvantage and whether this disparity is linked to geographic disparity in CRC survival. Methods: Data regarding previously diagnosed health conditions were collected via computer-assisted telephone interviews with a cross-sectional sample of n = 1,966 Australian CRC patients between 2003 and 2004. Ten-year survival outcomes were acquired in December 2014 from cancer registry data. Multivariate logistic regressions were applied to test associations between previously diagnosed health conditions and survival rates in rural, regional, and metropolitan areas. Results: Results suggest that only few geographical disparities exist in previously diagnosed health conditions for CRC patients and these were largely explained by socio-economic status and age. Living in an inner regional area was associated with cardio-vascular conditions, one or more respiratory diseases, and multiple respiratory diagnoses. Higher occurrences of these conditions did not explain lower CRC-specific 10 years survival rates in inner regional Australia. Conclusion: It is unlikely that health disparities in terms of previously diagnosed conditions account for poorer CRC survival in regional and remote areas. Interventions to improve the health of regional CRC patients may need to target issues unique to socio-economic disadvantage and older age.
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Affiliation(s)
- Belinda C Goodwin
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Sonja March
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,School of Psychology and Counseling, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Michael J Ireland
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,School of Psychology and Counseling, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Fiona Crawford-Williams
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia
| | - Shu-Kay Ng
- Menzies Health Institute, Griffith University, Southport, QLD, Australia
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Suzanne K Chambers
- Menzies Health Institute, Griffith University, Southport, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Public Health Fand Social Work, Queensland University of Technology, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jeff Dunn
- Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Toowoomba, QLD, Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia
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23
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Feller A, Schmidlin K, Bordoni A, Bouchardy C, Bulliard J, Camey B, Konzelmann I, Maspoli M, Wanner M, Zwahlen M, Clough‐Gorr KM. Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study. Cancer Med 2018; 7:1498-1510. [PMID: 29479854 PMCID: PMC5911574 DOI: 10.1002/cam4.1385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population-based CRC data from seven Swiss cantonal cancer registries 2001-2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow-up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non-Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97-1.19) and 1.28 (95% CI: 1.08-1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07-1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non-Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.
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Affiliation(s)
- Anita Feller
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
- National Institute for Cancer Epidemiology and Registration (NICER)Hirschengraben 828001ZürichSwitzerland
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
| | - Andrea Bordoni
- Ticino Cancer RegistryInstituto cantonale di patologiaVia in Selva 246601Locarno 1Switzerland
| | - Christine Bouchardy
- Geneva Cancer RegistryInstitute of Global HealthUniversity of GenevaBd de la Cluse 551205GenevaSwitzerland
| | - Jean‐Luc Bulliard
- Vaud Cancer RegistryUniversity Institute of Social and Preventive Medicine (IUMSP)Route de la Corniche 10, Bâtiment Biopôle 21010LausanneSwitzerland
| | - Bertrand Camey
- Fribourg Cancer RegistrySt. Nicolas de Flüe 21705FribourgSwitzerland
| | - Isabelle Konzelmann
- Health Observatory ValaisValais Cancer RegistryAvenue Grand‐Champsec 641950SionSwitzerland
| | - Manuela Maspoli
- Neuchâtel and Jura Cancer RegistryRue du Plan 302000NeuchâtelSwitzerland
| | - Miriam Wanner
- Cancer Registry Zurich and ZugBiostatistics and Prevention InstituteUniversity ZurichVogelsangstrasse 108091ZurichSwitzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
| | - Kerri M. Clough‐Gorr
- Institute of Social and Preventive Medicine (ISPM)University of BernFinkenhubelweg 11CH‐3012BernSwitzerland
- National Cancer Registry IrelandAirport Business Park6800CorkIreland
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24
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Ireland MJ, March S, Crawford-Williams F, Cassimatis M, Aitken JF, Hyde MK, Chambers SK, Sun J, Dunn J. A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 2017; 17:95. [PMID: 28152983 PMCID: PMC5290650 DOI: 10.1186/s12885-017-3067-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/18/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence of colorectal cancer (CRC) in the world, presenting considerable health, economic, and societal burden. Over a third of the Australian population live in regional areas and research has shown they experience a range of health disadvantages that result in a higher disease burden and lower life expectancy. The extent to which geographical disparities exist in CRC management and outcomes has not been systematically explored. The present review aims to identify the nature of geographical disparities in CRC survival, clinical management, and psychosocial outcomes. METHODS The review followed PRISMA guidelines and searches were undertaken using seven databases covering articles between 1 January 1990 and 20 April 2016 in an Australian setting. Inclusion criteria stipulated studies had to be peer-reviewed, in English, reporting data from Australia on CRC patients and relevant to one of fourteen questions examining geographical variations in a) survival outcomes, b) patient and cancer characteristics, c) diagnostic and treatment characteristics and d) psychosocial and quality of life outcomes. RESULTS Thirty-eight quantitative, two qualitative, and three mixed-methods studies met review criteria. Twenty-seven studies were of high quality, sixteen studies were of moderate quality, and no studies were found to be low quality. Individuals with CRC living in regional, rural, and remote areas of Australia showed poorer survival and experienced less optimal clinical management. However, this effect is likely moderated by a range of other factors (e.g., SES, age, gender) and did appear to vary linearly with increasing distance from metropolitan centres. No studies examined differences in use of stoma, or support with stomas, by geographic location. CONCLUSIONS Overall, despite evidence of disparity in CRC survival and clinical management across geographic locations, the evidence was limited and at times inconsistent. Further, access to treatment and services may not be the main driver of disparities, with individual patient characteristics and type of region also playing an important role. A better understanding of factors driving ongoing and significant geographical disparities in cancer related outcomes is required to inform the development of effective interventions to improve the health and welfare of regional Australians.
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Affiliation(s)
- Michael J. Ireland
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Sonja March
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Fiona Crawford-Williams
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- School of Psychology and Counselling, University of Southern Queensland, Springfield Central, Australia
| | - Mandy Cassimatis
- Non-communicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC Australia
| | - Joanne F. Aitken
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD Australia
| | - Melissa K. Hyde
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
| | - Suzanne K. Chambers
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
- Prostate Cancer Foundation of Australia, St Leonards, NSW Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA Australia
| | - Jiandong Sun
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Jeff Dunn
- Institute of Resilient Regions, University of Southern Queensland, Springfield Central, Australia
- Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, 4006 QLD Australia
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, QLD Australia
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25
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Cramb SM, Mengersen KL, Lambert PC, Ryan LM, Baade PD. A flexible parametric approach to examining spatial variation in relative survival. Stat Med 2016; 35:5448-5463. [PMID: 27503837 DOI: 10.1002/sim.7071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 06/30/2016] [Accepted: 07/12/2016] [Indexed: 11/10/2022]
Abstract
Most of the few published models used to obtain small-area estimates of relative survival are based on a generalized linear model with piecewise constant hazards under a Bayesian formulation. Limitations of these models include the need to artificially split the time scale, restricted ability to include continuous covariates, and limited predictive capacity. Here, an alternative Bayesian approach is proposed: a spatial flexible parametric relative survival model. This overcomes previous limitations by combining the benefits of flexible parametric models: the smooth, well-fitting baseline hazard functions and predictive ability, with the Bayesian benefits of robust and reliable small-area estimates. Both spatially structured and unstructured frailty components are included. Spatial smoothing is conducted using the intrinsic conditional autoregressive prior. The model was applied to breast, colorectal, and lung cancer data from the Queensland Cancer Registry across 478 geographical areas. Advantages of this approach include the ease of including more realistic complexity, the feasibility of using individual-level input data, and the capacity to conduct overall, cause-specific, and relative survival analysis within the same framework. Spatial flexible parametric survival models have great potential for exploring small-area survival inequalities, and we hope to stimulate further use of these models within wider contexts. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Susanna M Cramb
- Cancer Council Queensland, Brisbane, Australia.,ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia
| | - Kerrie L Mengersen
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology (QUT), Brisbane, Australia.,Cooperative Research Centre for Spatial Information, Melbourne, Australia
| | - Paul C Lambert
- Department of Health Sciences, University of Leicester, Leicester, U.K
| | - Louise M Ryan
- ARC Centre of Excellence for Mathematical and Statistical Frontiers, University of Technology, Sydney, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia.,School of Mathematical Sciences, Queensland University of Technology (QUT), Brisbane, Australia.,Menzies School of Health Research, Brisbane, Australia
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26
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Tervonen HE, Morrell S, Aranda S, Roder D, You H, Niyonsenga T, Walton R, Baker D, Currow D. The impact of geographic unit of analysis on socioeconomic inequalities in cancer survival and distant summary stage - a population-based study. Aust N Z J Public Health 2016; 41:130-136. [PMID: 27960223 DOI: 10.1111/1753-6405.12608] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/01/2016] [Accepted: 07/01/2016] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE When using area-level disadvantage measures, size of geographic unit can have major effects on recorded socioeconomic cancer disparities. This study examined the extent of changes in recorded socioeconomic inequalities in cancer survival and distant stage when the measure of socioeconomic disadvantage was based on smaller Census Collection Districts (CDs) instead of Statistical Local Areas (SLAs). METHODS Population-based New South Wales Cancer Registry data were used to identify cases diagnosed with primary invasive cancer in 2000-2008 (n=264,236). Logistic regression and competing risk regression modelling were performed to examine socioeconomic differences in odds of distant stage and hazard of cancer death for all sites combined and separately for breast, prostate, colorectal and lung cancers. RESULTS For all sites collectively, associations between socioeconomic disadvantage and cancer survival and distant stage were stronger when the CD-based socioeconomic disadvantage measure was used compared with the SLA-based measure. The CD-based measure showed a more consistent socioeconomic gradient with a linear upward trend of risk of cancer death/distant stage with increasing socioeconomic disadvantage. Site-specific analyses provided similar findings for the risk of death but less consistent results for the likelihood of distant stage. CONCLUSIONS The use of socioeconomic disadvantage measure based on the smallest available spatial unit should be encouraged in the future. Implications for public health: Disadvantage measures based on small spatial units can more accurately identify socioeconomic cancer disparities to inform priority settings in service planning.
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Affiliation(s)
- Hanna E Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia
| | - Stephen Morrell
- Information Analysis Unit, Cancer Institute NSW, New South Wales.,School of Public Health and Community Medicine, University of New South Wales
| | - Sanchia Aranda
- Cancer Council Australia, New South Wales.,Cancer Institute NSW, New South Wales
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia.,Cancer Institute NSW, New South Wales
| | - Hui You
- Information Analysis Unit, Cancer Institute NSW, New South Wales
| | - Theo Niyonsenga
- School of Health Sciences, Centre for Population Health Research, University of South Australia
| | - Richard Walton
- Information Analysis Unit, Cancer Institute NSW, New South Wales
| | - Deborah Baker
- Information Analysis Unit, Cancer Institute NSW, New South Wales.,Sax Institute, New South Wales
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27
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Valery PC, Bernardes CM, Beesley V, Hawkes AL, Baade P, Garvey G. Unmet supportive care needs of Australian Aboriginal and Torres Strait Islanders with cancer: a prospective, longitudinal study. Support Care Cancer 2016; 25:869-877. [DOI: 10.1007/s00520-016-3475-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022]
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28
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Spatio-temporal relative survival of breast and colorectal cancer in Queensland, Australia 2001–2011. Spat Spatiotemporal Epidemiol 2016; 19:103-114. [DOI: 10.1016/j.sste.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 07/01/2016] [Accepted: 08/25/2016] [Indexed: 12/12/2022]
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29
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Baade PD, Dasgupta P, Dickman PW, Cramb S, Williamson JD, Condon JR, Garvey G. Quantifying the changes in survival inequality for Indigenous people diagnosed with cancer in Queensland, Australia. Cancer Epidemiol 2016; 43:1-8. [DOI: 10.1016/j.canep.2016.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/30/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
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30
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Stanbury JF, Baade PD, Yu Y, Yu XQ. Impact of geographic area level on measuring socioeconomic disparities in cancer survival in New South Wales, Australia: A period analysis. Cancer Epidemiol 2016; 43:56-62. [PMID: 27391547 DOI: 10.1016/j.canep.2016.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Area-based socioeconomic measures are widely used in health research. In theory, the larger the area used the more individual misclassification is introduced, thus biasing the association between such area level measures and health outcomes. In this study, we examined the socioeconomic disparities in cancer survival using two geographic area-based measures to see if the size of the area matters. METHODS We used population-based cancer registry data for patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia during 2004-2008. Patients were assigned index measures of socioeconomic status (SES) based on two area-level units, census Collection District (CD) and Local Government Area (LGA) of their address at diagnosis. Five-year relative survival was estimated using the period approach for patients alive during 2004-2008, for each socioeconomic quintile at each area-level for each cancer. Poisson-regression modelling was used to adjust for socioeconomic quintile, sex, age-group at diagnosis and disease stage at diagnosis. The relative excess risk of death (RER) by socioeconomic quintile derived from this modelling was compared between area-units. RESULTS We found extensive disagreement in SES classification between CD and LGA levels across all socioeconomic quintiles, particularly for more disadvantaged groups. In general, more disadvantaged patients had significantly lower survival than the least disadvantaged group for both CD and LGA classifications. The socioeconomic survival disparities detected by CD classification were larger than those detected by LGA. Adjusted RER estimates by SES were similar for most cancers when measured at both area levels. CONCLUSIONS We found that classifying patient SES by the widely used Australian geographic unit LGA results in underestimation of survival disparities for several cancers compared to when SES is classified at the geographically smaller CD level. Despite this, our RER of death estimates derived from these survival estimates were generally similar for both CD and LGA level analyses, suggesting that LGAs remain a valuable spatial unit for use in Australian health and social research, though the potential for misclassification must be considered when interpreting research. While data confidentiality concerns increase with the level of geographical precision, the use of smaller area-level health and census data in the future, with appropriate allowance for confidentiality.
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Affiliation(s)
- Julia F Stanbury
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
| | - Peter D Baade
- Cancer Research Centre, Cancer Council Queensland, Brisbane, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
| | - Yan Yu
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
| | - Xue Qin Yu
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Cancer Research Division, Cancer Council New South Wales, Sydney, Australia.
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Tervonen HE, Aranda S, Roder D, Walton R, Baker D, You H, Currow D. Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence—A population-based cohort study in Australia. Cancer Epidemiol 2016; 41:132-8. [DOI: 10.1016/j.canep.2016.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/05/2016] [Accepted: 02/07/2016] [Indexed: 10/22/2022]
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Beckmann KR, Bennett A, Young GP, Cole SR, Joshi R, Adams J, Singhal N, Karapetis C, Wattchow D, Roder D. Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study. BMC Health Serv Res 2016; 16:24. [PMID: 26792195 PMCID: PMC4721049 DOI: 10.1186/s12913-016-1263-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in survival from colorectal cancer (CRC) across socioeconomic groups and by area of residence have been described in various health care settings. Few population-wide datasets which include clinical and treatment information are available in Australia to investigate disparities. This study examines socio-demographic differences in survival for CRC patients in South Australia (SA), using a population-wide database derived via linkage of administrative and surveillance datasets. METHODS The study population comprised all cases of CRC diagnosed in 2003-2008 among SA residents aged 50-79 yrs in the SA Central Cancer Registry. Measures of socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were derived through record linkage of central cancer registry, hospital-based clinical registries, hospital separations, and radiotherapy services data sources. Socio-demographic disparities in CRC survival were examined using competing risk regression analysis. RESULTS Four thousand six hundred and forty one eligible cases were followed for an average of 4.7 yrs, during which time 1525 died from CRC and 416 died from other causes. Results of competing risk regression indicated higher risk of CRC death with higher grade (HR high v low =2.25, 95% CI 1.32-3.84), later stage (HR C v A = 7.74, 95% CI 5.75-10.4), severe comorbidity (HR severe v none =1.21, 95% CI 1.02-1.44) and receiving radiotherapy (HR = 1.41, 95% CI 1.18-1.68). Patients from the most socioeconomically advantaged areas had significantly better outcomes than those from the least advantaged areas (HR =0.75, 95% 0.62-0.91). Patients residing in remote locations had significantly worse outcomes than metropolitan residents, though this was only evident for stages A-C (HR = 1.35, 95 % CI 1.01-1.80). These disparities were not explained by differences in stage at diagnosis between socioeconomic groups or area of residence. Nor were they explained by differences in patient factors, other tumour characteristics, comorbidity, or treatment modalities. CONCLUSIONS Socio-economic and regional disparities in survival following CRC are evident in SA, despite having a universal health care system. Of particular concern is the poorer survival for patients from remote areas with potentially curable CRC. Reasons for these disparities require further exploration to identify factors that can be addressed to improve outcomes.
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Affiliation(s)
- Kerri R. Beckmann
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Alice Bennett
- Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Graeme P. Young
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Stephen R. Cole
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
| | - Rohit Joshi
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Jacqui Adams
- Country Health SA, Adelaide, SA 5000 Australia
- Lyell McEwin Hospital, Elizabeth Vale, SA 5112 Australia
| | - Nimit Singhal
- Medical Oncologist, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA 5001 Australia
| | - Christos Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA 5042 Australia
- South Adelaide Health Network, Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042 Australia
| | - David Wattchow
- Flinders University, Flinders Medical Centre, Bedford Park, SA 5042 Australia
| | - David Roder
- Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
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Kikuti M, Cunha GM, Paploski IAD, Kasper AM, Silva MMO, Tavares AS, Cruz JS, Queiroz TL, Rodrigues MS, Santana PM, Lima HCAV, Calcagno J, Takahashi D, Gonçalves AHO, Araújo JMG, Gauthier K, Diuk-Wasser MA, Kitron U, Ko AI, Reis MG, Ribeiro GS. Spatial Distribution of Dengue in a Brazilian Urban Slum Setting: Role of Socioeconomic Gradient in Disease Risk. PLoS Negl Trop Dis 2015. [PMID: 26196686 PMCID: PMC4510880 DOI: 10.1371/journal.pntd.0003937] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Few studies of dengue have shown group-level associations between demographic, socioeconomic, or geographic characteristics and the spatial distribution of dengue within small urban areas. This study aimed to examine whether specific characteristics of an urban slum community were associated with the risk of dengue disease. Methodology/Principal Findings From 01/2009 to 12/2010, we conducted enhanced, community-based surveillance in the only public emergency unit in a slum in Salvador, Brazil to identify acute febrile illness (AFI) patients with laboratory evidence of dengue infection. Patient households were geocoded within census tracts (CTs). Demographic, socioeconomic, and geographical data were obtained from the 2010 national census. Associations between CTs characteristics and the spatial risk of both dengue and non-dengue AFI were assessed by Poisson log-normal and conditional auto-regressive models (CAR). We identified 651 (22.0%) dengue cases among 2,962 AFI patients. Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. All the four dengue serotypes were identified, but DENV2 predominated (DENV1: 8.1%; DENV2: 90.7%; DENV3: 0.4%; DENV4: 0.8%). Multivariable CAR regression analysis showed increased dengue risk in CTs with poorer inhabitants (RR: 1.02 for each percent increase in the frequency of families earning ≤1 times the minimum wage; 95% CI: 1.01-1.04), and decreased risk in CTs located farther from the health unit (RR: 0.87 for each 100 meter increase; 95% CI: 0.80-0.94). The same CTs characteristics were also associated with non-dengue AFI risk. Conclusions/Significance This study highlights the large burden of symptomatic dengue on individuals living in urban slums in Brazil. Lower neighborhood socioeconomic status was independently associated with increased risk of dengue, indicating that within slum communities with high levels of absolute poverty, factors associated with the social gradient influence dengue transmission. In addition, poor geographic access to health services may be a barrier to identifying both dengue and non-dengue AFI cases. Therefore, further spatial studies should account for this potential source of bias. Dengue is influenced by the environment; however, few studies have investigated the relationship between neighborhood characteristics and the spatial distribution of dengue within small urban areas. We examined whether specific characteristics of an urban slum community were associated with dengue risk. From January 2009 to December 2010, we conducted community-based surveillance in a slum in Salvador, Brazil to identify patients with acute febrile illness (AFI) and to test them for dengue. We identified 651 (22.0%) patients with laboratory evidence of dengue infection among 2,962 AFI patients. All the four dengue serotypes were detected, but DENV2 predominated (DENV1 8.1%; DENV2 90.7%; DENV3 0.4%; DENV4 0.8%). Estimated risk of symptomatic dengue was 21.3 and 70.2 cases per 10,000 inhabitants in 2009 and 2010, respectively. We found that neighborhood poverty level and proximity to the health center were associated with higher risk of detection of dengue and other AFI. This study highlights the large burden of dengue in poor urban slums of Brazil and indicates that socioeconomic development could potentially mitigate risk factors for both dengue and non-dengue AFI cases. In addition, we found that residential proximity to a health care facility was associated with improved case detection. Therefore, further studies on disease distribution should consider household proximity to health care facilities when assessing risk.
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Affiliation(s)
- Mariana Kikuti
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Geraldo M. Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Igor A. D. Paploski
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Amelia M. Kasper
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Monaise M. O. Silva
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Aline S. Tavares
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Jaqueline S. Cruz
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Tássia L. Queiroz
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Moreno S. Rodrigues
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Perla M. Santana
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Helena C. A. V. Lima
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Juan Calcagno
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Daniele Takahashi
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Josélio M. G. Araújo
- Departamento de Microbiologia e Parasitologia, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kristine Gauthier
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Maria A. Diuk-Wasser
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Uriel Kitron
- Department of Environmental Studies, Emory University, Atlanta, Georgia, United States of America
| | - Albert I. Ko
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Mitermayer G. Reis
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
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Diaz A, Whop LJ, Valery PC, Moore SP, Cunningham J, Garvey G, Condon JR. Cancer outcomes for Aboriginal and Torres Strait Islander Australians in rural and remote areas. Aust J Rural Health 2015; 23:4-18. [DOI: 10.1111/ajr.12169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- Abbey Diaz
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - Lisa J. Whop
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - Patricia C. Valery
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - Suzanne P. Moore
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - Joan Cunningham
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - Gail Garvey
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
| | - John R. Condon
- Epidemiology and Health Services Division; Cancer Epidemiology; Menzies School of Health Research; Casuarina Northern Territory Australia
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Sankaranarayanan J, Qiu F, Watanabe-Galloway S. A registry study of the association of patient's residence and age with colorectal cancer survival. Expert Rev Pharmacoecon Outcomes Res 2014; 14:301-13. [PMID: 24625041 DOI: 10.1586/14737167.2014.891441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Because of limited literature from rural states of the United States like Nebraska, we evaluated the association of patient's age, Office of Management and Budget residence-county categories (rural-nonmetro, micropolitan-nonmetro, urban), and significant interactions between confounding-variables with colorectal cancer (CRC) survival. This retrospective 1998-2003 study of 6561 CRC patients from the Nebraska Cancer Registry showed median patient survival in colon and rectal cancer in urban, rural and micropolitan counties were 33, 36, and 46 months and 41, 47, 49 months, respectively. In Cox proportional-hazards analyses, after adjusting for significant demographics (age, race, marital status in colon cancer; age, insurance status in rectal cancer), cancer stage, surgery and radiation treatments; 1) no-chemotherapy urban colon cancer patients had significantly shorter survival (rural vs urban; adjusted hazard ratio, HR: 0.78 or urban vs rural HR: 1.28; micropolitan vs urban, HR: 0.78) and 2) no-surgery urban (vs rural, HR: 1.49); micropolitan (vs rural, HR: 2.01) rectal cancer patients had significantly shorter survival. Colon cancer (≥65 years) and rectal cancer (≥75 years) elderly each versus patients aged 19-64 years old had significantly shorter survival (all p < 0.01). The association of patients' age and treatment/residence-county interactions with CRC survival warrant decision-makers' attention.
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Dasgupta P, Cramb SM, Aitken JF, Turrell G, Baade PD. Comparing multilevel and Bayesian spatial random effects survival models to assess geographical inequalities in colorectal cancer survival: a case study. Int J Health Geogr 2014; 13:36. [PMID: 25280499 PMCID: PMC4197252 DOI: 10.1186/1476-072x-13-36] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multilevel and spatial models are being increasingly used to obtain substantive information on area-level inequalities in cancer survival. Multilevel models assume independent geographical areas, whereas spatial models explicitly incorporate geographical correlation, often via a conditional autoregressive prior. However the relative merits of these methods for large population-based studies have not been explored. Using a case-study approach, we report on the implications of using multilevel and spatial survival models to study geographical inequalities in all-cause survival. METHODS Multilevel discrete-time and Bayesian spatial survival models were used to study geographical inequalities in all-cause survival for a population-based colorectal cancer cohort of 22,727 cases aged 20-84 years diagnosed during 1997-2007 from Queensland, Australia. RESULTS Both approaches were viable on this large dataset, and produced similar estimates of the fixed effects. After adding area-level covariates, the between-area variability in survival using multilevel discrete-time models was no longer significant. Spatial inequalities in survival were also markedly reduced after adjusting for aggregated area-level covariates. Only the multilevel approach however, provided an estimation of the contribution of geographical variation to the total variation in survival between individual patients. CONCLUSIONS With little difference observed between the two approaches in the estimation of fixed effects, multilevel models should be favored if there is a clear hierarchical data structure and measuring the independent impact of individual- and area-level effects on survival differences is of primary interest. Bayesian spatial analyses may be preferred if spatial correlation between areas is important and if the priority is to assess small-area variations in survival and map spatial patterns. Both approaches can be readily fitted to geographically enabled survival data from international settings.
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Affiliation(s)
| | | | | | | | - Peter D Baade
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4004, Australia.
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