title: Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study.
abstract: BACKGROUND
  Reducing disparities in cancer outcomes is a major priority for cancer-control agencies. The authors examine the relationships between geographic remoteness, area disadvantage and risk of advanced breast cancer among women.
  
  
  METHODS
  Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced breast cancer among women aged 30-79 years diagnosed as having breast cancer in Queensland, Australia between 1997 and 2006 (n=18,658).
  
  
  RESULTS
  Women who resided in the most socio-economically disadvantaged areas were significantly more likely (OR 1.21, 95% CI 1.07 to 1.37) than residents of the most advantaged areas to be diagnosed as having advanced breast cancer after adjustment for individual-level factors. When geographic remoteness and area-disadvantage (and all the individual-level factors) were simultaneously adjusted, the rates of advanced breast cancer were significantly higher for women residing in Outer Regional areas (OR 1.13, 95% CI 1.02 to 1.24) and those who lived in the most disadvantaged areas (OR 1.16, 95% CI 1.02 to 1.32). There was no statistically significant interaction between geographic remoteness and area disadvantage.
  
  
  CONCLUSIONS
  A woman's risk of being diagnosed as having advanced breast cancer depends on where she lives, separate from the individual characteristics of the woman herself. Both the rurality and socio-economic characteristics of the geographical area in which women lived were important. The socio-economic factors contributing to advanced breast cancer, existing in both urban and rural environments, need to be investigated.
authors.affiliation: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, Spring Hill, QLD 4001, Australia. peterbaade@cancerqld.org.au
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
authors.forename: Gavin
authors.initials: G
authors.lastname: Turrell
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D011793:Queensland; D012424:Rural Population; D012720:Severity of Illness Index; D012923:Social Class