title: The first year counts: cancer survival among Indigenous and non-Indigenous Queenslanders, 1997-2006.
abstract: OBJECTIVE
  To examine the differential in cancer survival between Indigenous and non-Indigenous people in Queensland in relation to time after diagnosis, remoteness and area-socioeconomic disadvantage.
  
  
  METHODS
  Descriptive study of population-based data on all 150,059 Queensland residents of known Indigenous status aged 15 years and over who were diagnosed with a primary invasive cancer during 1997-2006.
  
  
  METHODS
  Hazard ratios for the categories of area-socioeconomic disadvantage, remoteness and Indigenous status, as well as conditional 5-year survival estimates.
  
  
  RESULTS
  Five-year survival was lower for Indigenous people diagnosed with cancer (50.3%; 95% CI, 47.8%-52.8%) compared with non-Indigenous people (61.9%; 95% CI, 61.7%-62.2%). There was no evidence that this differential varied by remoteness (P = 0.780) or area-socioeconomic disadvantage (P = 0.845). However, it did vary by time after diagnosis. In a time-varying survival model stratified by age, sex and cancer type, the 50% excess mortality in the first year (adjusted HR, 1.50; 95% CI, 1.38-1.63) reduced to near unity at 2 years after diagnosis (HR, 1.03; 95% CI, 0.78-1.35).
  
  
  CONCLUSIONS
  After a wide disparity in cancer survival in the first 2 years after diagnosis, Indigenous patients with cancer who survive these 2 years have a similar outlook to non-Indigenous patients. Access to services and socioeconomic factors are unlikely to be the main causes of the early lower Indigenous survival, as patterns were similar across remoteness and area-socioeconomic disadvantage. There is an urgent need to identify the factors leading to poor outcomes early after diagnosis among Indigenous people with cancer.
authors.affiliation: Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, QLD.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Cramb
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
authors.forename: John D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006303:Health Services, Indigenous / Q000592:standards / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality*; D044382:Population Groups / Q000208:ethnology*; D011793:Queensland; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult