title: Urban Rural Differences in Breast Cancer in New Zealand.
abstract: Many rural communities have poor access to health services due to a combination of distance from specialist services and a relative shortage of general practitioners. Our aims were to compare the characteristics of urban and rural women with breast cancer in New Zealand, to assess breast cancer-specific and all-cause survival using the Kaplan-Meier method and Cox proportional hazards model, and to assess whether the impact of rurality is different for Māori and New Zealand (NZ) European women. We found that rural women tended to be older and were more likely to be Māori. Overall there were no differences between urban and rural women with regards their survival. Rural Māori tended to be older, more likely to be diagnosed with metastatic disease and less likely to be screen detected than urban Māori. Rural Māori women had inferior breast cancer-specific survival and all-cause survival at 10 years at 72.1% and 55.8% compared to 77.9% and 64.9% for urban Māori. The study shows that rather than being concerned that more needs to be done for rural women in general it is rural Māori women where we need to make extra efforts to ensure early stage at diagnosis and optimum treatment.
authors.affiliation: National Institute of Demographic and Economic Analysis, The University of Waikato, Hamilton 3240, New Zealand. Ross.Lawrenson@waikatodhb.health.nz.
authors.forename: Ross
authors.initials: R
authors.lastname: Lawrenson
authors.affiliation: National Institute of Demographic and Economic Analysis, The University of Waikato, Hamilton 3240, New Zealand. clao@waikato.ac.nz.
authors.forename: Chunhuan
authors.initials: C
authors.lastname: Lao
authors.affiliation: School of Population Health, The University of Auckland, Auckland 1142, New Zealand. mark.elwood@auckland.ac.nz.
authors.forename: Mark
authors.initials: M
authors.lastname: Elwood
authors.affiliation: National Institute of Demographic and Economic Analysis, The University of Waikato, Hamilton 3240, New Zealand. charis@waikato.ac.nz.
authors.forename: Charis
authors.initials: C
authors.lastname: Brown
authors.affiliation: Department of Public Health, The University of Otago, Wellington 6021, New Zealand. diana.sarfati@otago.ac.nz.
authors.forename: Diana
authors.initials: D
authors.lastname: Sarfati
authors.affiliation: School of Medicine, The University of Auckland, Auckland 1142, New Zealand. Ian.campbell@waikatodhb.health.nz.
authors.forename: Ian
authors.initials: I
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D044382:Population Groups / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Māori; breast cancer; equity; rural; survival; urban