title: Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia.
abstract: OBJECTIVE
  Incidence and mortality of hepatocellular carcinoma (HCC) is increasing globally, but varies between countries and regions. To target scarce resources to most need, clinical services must be informed by regional epidemiology. Using population-based data, we sought to document the incidence and mortality of HCC in Queensland, Australia, a state occupying a vast land area with diverse at-risk subpopulations.
  
  
  METHODS
  Using population-based data from 1996 to 2011, the age-standardised incidence rate (ASR), annual percentage change (APC) and survival of HCC in Queensland were assessed with negative binomial regression, Kaplan-Meier and Cox survival analysis. Spatial patterns of HCC incidence and survival and relevant predictors were mapped.
  
  
  RESULTS
  Thousand six hundred and twenty HCCs were diagnosed during this study period, with an overall ASR of 2.00-cases/1000 population. ASR increased by 3.5% per year, (95% CI: 2.1 to 5.0), P < 0.001) among males to 5.6/100,000 in 2011 and a non-significant increase of 2.6% per year, (95% CI = -0.7 to 6.0), P = 0.111) among females to 1.6/100,000 in 2011. Higher incidence was associated with male gender, older age, major city residence and proportionally higher area Indigenous population. Thousand and two hundred and eighty-seven patients died. Median survival was approximately 10 months. Five-year survival improved from 18% in 1996-2000 to 24% in 2006-2011 (P < 0.001). Poorer survival was associated with older age, less recent period of diagnosis, lower hepatitis B prevalence in country of origin and greater area-level social disadvantage.
  
  
  CONCLUSIONS
  Over this study period, HCC incidence increased significantly. HCC survival improved but remains poor. Social determinants are critical to HCC epidemiology.
authors.affiliation: Cancer Control Unit, QIMR-Berghofer Medical Research Institute, Brisbane, Qld, Australia.|Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Qld, Australia.|School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Clark
authors.affiliation: Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Stuart
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.|Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Leggett
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: Darrell H
authors.initials: DH
authors.lastname: Crawford
authors.affiliation: Cairns Base Hospital, Cairns, Qld, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Boyd
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.|Hepato-Pancreato-Biliary Surgery Unit, Princess Alexandra Hospital, Brisbane, Qld, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fawcett
authors.affiliation: Cancer Control Unit, QIMR-Berghofer Medical Research Institute, Brisbane, Qld, Australia.|School of Medicine, University of Queensland, Brisbane, Qld, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.affiliation: School of Medicine, University of Queensland, Brisbane, Qld, Australia.|Epidemiology, Cancer Council Queensland, Brisbane, Qld, Australia.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Baade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology; D003710:Demography; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis
keywords: epidemiology; geographical information system; hepatocellular carcinoma; liver cancer; population-based; social determinants of disease