title: Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and survival by level of socio-economic disadvantage and remoteness of residence-A population-based cohort study in Australia.
abstract: BACKGROUND
  Aboriginal and Torres Strait Islander people (referred to in this paper as "Aboriginal people") generally have lower cancer survivals and more advanced stages at diagnosis than non-Aboriginal people. There is conflicting evidence on whether these disparities vary by socio-economic disadvantage and geographic remoteness. This study examines variations in these disparities in New South Wales (NSW), Australia.
  
  
  METHODS
  Data for cancers diagnosed in 2000-2008 were extracted from the NSW Cancer Registry (n=264,219). Missing Aboriginal status (13.3%) was multiply imputed. Logistic regression and competing risk regression models were used to examine likelihood of advanced summary stage and risk of cancer death among Aboriginal compared with non-Aboriginal people by socio-economic disadvantage (categorised into quintiles 1: least disadvantaged-5: most disadvantaged) and remoteness.
  
  
  RESULTS
  Aboriginal people showed a general pattern of more advanced stage at diagnosis compared with non-Aboriginal people across socio-economic disadvantage and remoteness categories. After adjusting for demographic factors, year of diagnosis, summary stage and cancer site, Aboriginal people living outside the least disadvantaged areas had an increased risk of cancer death compared with non-Aboriginal people living in similar areas (sub-hazard ratio SHR 1.41, 95% confidence interval CI 1.09-1.81; SHR 1.59, 95%CI 1.31-1.93; SHR 1.42, 95%CI 1.22-1.64 and SHR 1.34, 95%CI 1.22-1.48 for quintiles 2-5, respectively). Compared with non-Aboriginal people, Aboriginal people had an elevation in the risk of cancer death irrespective of the remoteness, with the most pronounced elevations detected in remote/very remote areas (SHR 1.56, 95%CI 1.10-2.21).
  
  
  CONCLUSIONS
  Compared with non-Aboriginal people, Aboriginal people had a higher risk of cancer death and higher likelihood of more advanced stage across socio-economic disadvantage and remoteness categories. All areas appear to require attention in endeavours to improve cancer survival outcomes for Aboriginal people.
authors.affiliation: School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Electronic address: hanna.tervonen@unisa.edu.au.
authors.forename: Hanna E
authors.initials: HE
authors.lastname: Tervonen
authors.affiliation: Cancer Council Australia, GPO Box 4708, Sydney, NSW 2001, Australia; Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia; School of Health Sciences, University of Melbourne, 161 Barry Street, Carlton, Victoria 3053, Australia.
authors.forename: Sanchia
authors.initials: S
authors.lastname: Aranda
authors.affiliation: School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia; Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Roder
authors.affiliation: Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Walton
authors.affiliation: Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Baker
authors.affiliation: Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: Hui
authors.initials: H
authors.lastname: You
authors.affiliation: Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW 1435, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Currow
mesh_terms: D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000453:epidemiology*; D009517:New South Wales / Q000453:epidemiology; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
keywords: Australia; Indigenous; Neoplasms; Rural population; Socioeconomic factors