title: Sociodemographic disparities in survival from colorectal cancer in South Australia: a population-wide data linkage study.
abstract: BACKGROUND
  Inequalities in survival from colorectal cancer (CRC) across socioeconomic groups and by area of residence have been described in various health care settings. Few population-wide datasets which include clinical and treatment information are available in Australia to investigate disparities. This study examines socio-demographic differences in survival for CRC patients in South Australia (SA), using a population-wide database derived via linkage of administrative and surveillance datasets.
  
  
  METHODS
  The study population comprised all cases of CRC diagnosed in 2003-2008 among SA residents aged 50-79 yrs in the SA Central Cancer Registry. Measures of socioeconomic status (area level), geographical remoteness, clinical characteristics, comorbid conditions, treatments and outcomes were derived through record linkage of central cancer registry, hospital-based clinical registries, hospital separations, and radiotherapy services data sources. Socio-demographic disparities in CRC survival were examined using competing risk regression analysis.
  
  
  RESULTS
  Four thousand six hundred and forty one eligible cases were followed for an average of 4.7 yrs, during which time 1525 died from CRC and 416 died from other causes. Results of competing risk regression indicated higher risk of CRC death with higher grade (HR high v low =2.25, 95% CI 1.32-3.84), later stage (HR C v A = 7.74, 95% CI 5.75-10.4), severe comorbidity (HR severe v none =1.21, 95% CI 1.02-1.44) and receiving radiotherapy (HR = 1.41, 95% CI 1.18-1.68). Patients from the most socioeconomically advantaged areas had significantly better outcomes than those from the least advantaged areas (HR =0.75, 95% 0.62-0.91). Patients residing in remote locations had significantly worse outcomes than metropolitan residents, though this was only evident for stages A-C (HR = 1.35, 95 % CI 1.01-1.80). These disparities were not explained by differences in stage at diagnosis between socioeconomic groups or area of residence. Nor were they explained by differences in patient factors, other tumour characteristics, comorbidity, or treatment modalities.
  
  
  CONCLUSIONS
  Socio-economic and regional disparities in survival following CRC are evident in SA, despite having a universal health care system. Of particular concern is the poorer survival for patients from remote areas with potentially curable CRC. Reasons for these disparities require further exploration to identify factors that can be addressed to improve outcomes.
authors.affiliation: Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia. kerri.beckmann@unisa.edu.au.
authors.forename: Kerri R
authors.initials: KR
authors.lastname: Beckmann
authors.affiliation: Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
authors.forename: Alice
authors.initials: A
authors.lastname: Bennett
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Young
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.
authors.forename: Rohit
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Country Health SA, Adelaide, SA, 5000, Australia.|Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.
authors.forename: Jacqui
authors.initials: J
authors.lastname: Adams
authors.affiliation: Medical Oncologist, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, 5001, Australia.
authors.forename: Nimit
authors.initials: N
authors.lastname: Singhal
authors.affiliation: Flinders Centre for Innovation in Cancer, Flinders University, Flinders Drive, Bedford Park, SA, 5042, Australia.|South Adelaide Health Network, Medical Oncology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
authors.forename: Christos
authors.initials: C
authors.lastname: Karapetis
authors.affiliation: Flinders University, Flinders Medical Centre, Bedford Park, SA, 5042, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Wattchow
authors.affiliation: Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Roder
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D015897:Comorbidity; D016208:Databases, Factual; D003710:Demography; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012923:Social Class; D012959:Socioeconomic Factors; D013021:South Australia