title: Survival disparities in Australia: an analysis of patterns of care and comorbidities among indigenous and non-indigenous cancer patients.
abstract: BACKGROUND
  Indigenous Australians have lower overall cancer survival which has not yet been fully explained. To address this knowledge deficit, we investigated the associations between comorbidities, cancer treatment and survival in Indigenous and non-Indigenous people in Queensland, Australia.
  
  
  METHODS
  A cohort study of 956 Indigenous and 869 non-Indigenous patients diagnosed with cancer during 1998-2004, frequency-matched on age, sex, remoteness of residence and cancer type, and treated in Queensland public hospitals. Survival after cancer diagnosis, and effect of stage, treatment, and comorbidities on survival were examined using Cox proportional hazard models.
  
  
  RESULTS
  Overall Indigenous people had more advanced cancer stage (p = 0.03), more comorbidities (p < 0.001), and received less cancer treatment (77% vs. 86%, p = 0.001). Among patients without comorbidities and social disadvantage, there was a lower uptake of treatment among Indigenous patients compared to non-Indigenous patients. For those who received treatment, time to commencement, duration and dose of treatment were comparable. Unadjusted cancer survival (HR = 1.30, 95% CI 1.15-1.48) and non-cancer survival (HR = 2.39, 95% CI 1.57-3.63) were lower in the Indigenous relative to non-Indigenous patients over the follow-up period. When adjusted for clinical factors, there was no difference in cancer-specific survival between the groups (HR = 1.10, 95% CI 0.96-1.27). One-year survival was lower for Indigenous people for all-causes of death (adjusted HR = 1.33, 95% CI 1.12-1.83).
  
  
  CONCLUSIONS
  In this study, Indigenous Australians received less cancer treatment, had more comorbidities and had more advanced cancer stage at diagnosis, factors which contribute to poorer cancer survival. Moreover, for patients with a more favourable distribution of such prognostic factors, Indigenous patients received less treatment overall relative to non-Indigenous patients. Personalised cancer care, which addresses the clinical, social and overall health requirements of Indigenous patients, may improve their cancer outcomes.
authors.affiliation: Menzies School of Health Research, 147 Wharf St, Spring Hill, Brisbane 4000, Australia. Suzanne.Moore@menzies.edu.au.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Moore
authors.forename: Adèle C
authors.initials: AC
authors.lastname: Green
authors.forename: Freddie
authors.initials: F
authors.lastname: Bray
authors.forename: Gail
authors.initials: G
authors.lastname: Garvey
authors.forename: Michael
authors.initials: M
authors.lastname: Coory
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martin
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D011793:Queensland / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult