title: Identification of area-level influences on regions of high cancer incidence in Queensland, Australia: a classification tree approach.
abstract: BACKGROUND
  Strategies for cancer reduction and management are targeted at both individual and area levels. Area-level strategies require careful understanding of geographic differences in cancer incidence, in particular the association with factors such as socioeconomic status, ethnicity and accessibility. This study aimed to identify the complex interplay of area-level factors associated with high area-specific incidence of Australian priority cancers using a classification and regression tree (CART) approach.
  
  
  METHODS
  Area-specific smoothed standardised incidence ratios were estimated for priority-area cancers across 478 statistical local areas in Queensland, Australia (1998-2007, n = 186,075). For those cancers with significant spatial variation, CART models were used to identify whether area-level accessibility, socioeconomic status and ethnicity were associated with high area-specific incidence.
  
  
  RESULTS
  The accessibility of a person's residence had the most consistent association with the risk of cancer diagnosis across the specific cancers. Many cancers were likely to have high incidence in more urban areas, although male lung cancer and cervical cancer tended to have high incidence in more remote areas. The impact of socioeconomic status and ethnicity on these associations differed by type of cancer.
  
  
  CONCLUSIONS
  These results highlight the complex interactions between accessibility, socioeconomic status and ethnicity in determining cancer incidence risk.
authors.affiliation: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Gregory Tce, Fortitude Valley, Australia. susannacramb@cancerqld.org.au
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Cramb
authors.forename: Kerrie L
authors.initials: KL
authors.lastname: Mengersen
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology; D005260:Female; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008545:Melanoma / Q000453:epidemiology; D009369:Neoplasms / Q000145:classification / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000453:epidemiology; D011793:Queensland / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology