title: Indigenous inequities in the presentation and management of stomach cancer in New Zealand: a country with universal health care coverage.
abstract: BACKGROUND
  Māori in New Zealand have markedly higher incidence and poorer survival from stomach cancer than non-Māori. We investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients.
  
  
  METHODS
  A clinical notes review of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori, was conducted (final cohort n = 335). Patient characteristics, tumour characteristics, receipt and timing of treatment and cancer-specific survival were compared.
  
  
  RESULTS
  Compared to non-Māori, Māori patients had a younger average age at diagnosis, higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43 % Māori, 26 % non-Māori, p = 0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66 %) of stage I-III patients had definitive surgery, with similar rates for Māori (71 %) and non-Māori (68 %). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38 % Māori, 79 % non-Māori, p < 0.01) and less likely to be treated in a main centre (44 % Māori, 87 % non-Māori, p < 0.01). After adjusting for age, sex, stage, tumour site and comorbidity, Māori had nonsignificant 27 % poorer survival (hazard ratio 1.27, 95 % CI 0.96-1.68).
  
  
  CONCLUSIONS
  There was evidence of differential presentation and access to specialised surgical services, as well as differential survival, for Māori stomach cancer patients compared to non-Māori. These findings support the development of the national stomach cancer treatment standards and highlight the need for an equity focus within these guidelines.
authors.affiliation: Department of Public Health, University of Otago, 23a Mein Street, Newtown, Wellington, New Zealand, virginia.signal@otago.ac.nz.
authors.forename: Virginia
authors.initials: V
authors.lastname: Signal
authors.forename: Diana
authors.initials: D
authors.lastname: Sarfati
authors.forename: Ruth
authors.initials: R
authors.lastname: Cunningham
authors.forename: Jason
authors.initials: J
authors.lastname: Gurney
authors.forename: Jonathon
authors.initials: J
authors.lastname: Koea
authors.forename: Lis
authors.initials: L
authors.lastname: Ellison-Loschmann
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000628:therapy*
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