A multilevel study of the determinants of area-level inequalities in colorectal cancer survival

Baade, Peter D., Turrell, Gavin and Aitken, Joanne F. (2010) A multilevel study of the determinants of area-level inequalities in colorectal cancer survival. BMC Cancer, 10 Article # 24: 1-8. doi:10.1186/1471-2407-10-24

Author Baade, Peter D.
Turrell, Gavin
Aitken, Joanne F.
Title A multilevel study of the determinants of area-level inequalities in colorectal cancer survival
Journal name BMC Cancer   Check publisher's open access policy
ISSN 1471-2407
Publication date 2010-01
Sub-type Article (original research)
DOI 10.1186/1471-2407-10-24
Open Access Status DOI
Volume 10
Issue Article # 24
Start page 1
End page 8
Total pages 8
Place of publication London
Publisher BioMed Central
Collection year 2011
Language eng
Formatted abstract
Background: In Australia, associations between geographic remoteness, socioeconomic disadvantage, and colorectal cancer (CRC) survival show that survival rates are lowest among residents of geographically remote regions and those living in disadvantaged areas. At present we know very little about the reasons for these inequalities, hence our capacity to intervene to reduce the inequalities is limited.Methods/Design: This study, the first of its type in Australia, examines the association between CRC survival and key area- and individual-level factors. Specifically, we will use a multilevel framework to investigate the possible determinants of area- and individual-level inequalities in CRC survival and quantify the relative contribution of geographic remoteness, socioeconomic and demographic factors, disease stage, and access to diagnostic and treatment services, to these inequalities. The multilevel analysis will be based on survival data relating to people diagnosed with CRC in Queensland between 1996 and 2005 (n = 22,723) from the Queensland Cancer Registry (QCR), area-level data from other data custodians such as the Australian Bureau of Statistics, and individual-level data from the QCR (including extracting stage from pathology records) and Queensland Hospitals. For a subset of this period (2003 and 2004) we will utilise more detailed, individual-level data (n = 1,966) covering a greater range of risk factors from a concurrent research study. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to treatment centres. The analyses will be conducted using a multilevel Cox proportional hazards model with Level 1 comprising individual-level factors (e.g. occupation) and level 2 area-level indicators of remoteness and area socioeconomic disadvantage.Discussion: This study focuses on the health inequalities for rural and disadvantaged populations that have often been documented but poorly understood, hence limiting our capacity to intervene. This study utilises and develops emerging statistical and spatial technologies that can then be applied to other cancers and health outcomes. The findings of this study will have direct implications for the targeting and resourcing of cancer control programs designed to reduce the burden of colorectal cancer, and for the provision of diagnostic and treatment services.
© 2010 Baade et al; licensee BioMed Central Ltd.
Keyword Stage Breast-cancer
Socioeconomic Inequalities
Indigenous Australians
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Received: 8 December 2009 Accepted: 28 January 2010 Published: 28 January 2010

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
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Created: Sun, 28 Mar 2010, 00:06:55 EST