title: Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study.
abstract: BACKGROUND
  We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer.
  
  
  METHODS
  Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced disease among people aged 20-79 years diagnosed with colorectal cancer in Queensland, Australia between 1997 and 2007 (n=18,561).
  
  
  RESULTS
  Multilevel analysis showed that colorectal cancer patients living in inner regional (OR=1.09, 1.01-1.19) and outer regional (OR=1.11, 1.01-1.22) areas were significantly more likely to be diagnosed with advanced cancer than those in major cities (P=0.045) after adjusting for individual-level variables. The best-fitting final model did not include area disadvantage. Stratified analysis suggested this remoteness effect was limited to people diagnosed with colon cancer (P=0.048) and not significant for rectal cancer patients (P=0.873).
  
  
  CONCLUSIONS
  Given the relationship between stage and survival outcomes, it is imperative that the reasons for these rurality inequities in advanced disease be identified and addressed.
authors: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, QLD 4004, Australia. peterbaade@cancerqld.org.au
authors: P D
authors: PD
authors: Baade
authors: P
authors: P
authors: Dasgupta
authors: J
authors: J
authors: Aitken
authors: G
authors: G
authors: Turrell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005843:Geography; D054624:Health Status Disparities; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011379:Prognosis; D011793:Queensland; D012307:Risk Factors; D012923:Social Class; D015996:Survival Rate; D055815:Young Adult