Viertel Centre for Research in Cancer Control, Cancer Council Queensland, PO Box 201, 4004, Spring Hill, Brisbane, QLD, Australia.
Breast Cancer Res Treat. 2012 Apr;132(2):701-10. doi: 10.1007/s10549-011-1899-y. Epub 2011 Dec 9.
A major priority for cancer control agencies is to reduce geographical inequalities in cancer outcomes. While the poorer breast cancer survival among socioeconomically disadvantaged women is well established, few studies have looked at the independent contribution that area- and individual-level factors make to breast cancer survival. Here, we examine relationships between geographic remoteness, area-level socioeconomic disadvantage and breast cancer survival after adjustment for patients' socio-demographic characteristics and stage at diagnosis. Multilevel logistic regression and Markov chain Monte Carlo simulation were used to analyze 18,568 breast cancer cases extracted from the Queensland Cancer Registry for women aged 30-70 years diagnosed between 1997 and 2006 from 478 Statistical Local Areas in Queensland, Australia. Independent of individual-level factors, area-level disadvantage was associated with breast cancer survival (P = 0.032). Compared to women in the least disadvantaged quintile (quintile 5), women diagnosed while resident in one of the remaining four quintiles had significantly worse survival (OR 1.23, 1.27, 1.30, 1.37 for quintiles 4, 3, 2, and 1, respectively). Geographic remoteness was not related to lower survival after multivariable adjustment. There was no evidence that the impact of area-level disadvantage varied by geographic remoteness. At the individual-level, Indigenous status, blue collar occupations and advanced disease were important predictors of poorer survival. A woman's survival after a diagnosis of breast cancer depends on the socio-economic characteristics of the area where she lives, independently of her individual-level characteristics. It is crucial that the underlying reasons for these inequalities be identified to appropriately target policies, resources and effective intervention strategies.
癌症控制机构的一个主要优先事项是减少癌症结果的地域不平等。虽然社会经济处于不利地位的女性乳腺癌生存率较低已经得到证实，但很少有研究关注地区和个人层面因素对乳腺癌生存率的独立贡献。在这里，我们在调整了患者的社会人口特征和诊断时的阶段后，研究了地理偏远程度、地区社会经济劣势与乳腺癌生存之间的关系。多水平逻辑回归和马尔可夫链蒙特卡罗模拟用于分析从澳大利亚昆士兰州癌症登记处提取的 18568 例年龄在 30-70 岁之间的女性乳腺癌病例，这些女性于 1997 年至 2006 年间在昆士兰州的 478 个统计地方区域被诊断出患有乳腺癌。独立于个体因素，地区劣势与乳腺癌生存率相关（P=0.032）。与处于最不利五分位数（五分位数 5）的女性相比，居住在其余四个五分位数中的女性的诊断生存率显著较差（五分位数 4、3、2 和 1 的 OR 分别为 1.23、1.27、1.30 和 1.37）。经过多变量调整后，地理偏远程度与较低的生存率无关。没有证据表明地区劣势的影响因地理偏远程度而异。在个体层面上，原住民身份、蓝领职业和晚期疾病是生存率较差的重要预测因素。女性在被诊断出患有乳腺癌后能否生存，取决于她所居住地区的社会经济特征，而与她的个体特征无关。确定这些不平等现象的根本原因，以有针对性地制定政策、资源和有效的干预策略至关重要。
