澳大利亚一项基于人群的队列研究：原住民和托雷斯海峡岛民身份对癌症分期及生存的影响因社会经济劣势程度和居住偏远程度而异。
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.
作者信息
Tervonen Hanna E, Aranda Sanchia, Roder David, Walton Richard, Baker Deborah, You Hui, Currow David
机构信息
School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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.
出版信息
Cancer Epidemiol. 2016 Apr;41:132-8. doi: 10.1016/j.canep.2016.02.006. Epub 2016 Mar 5.
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).
CONCLUSION
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.
背景
澳大利亚原住民和托雷斯海峡岛民（本文简称为“原住民”）通常比非原住民的癌症生存率更低，确诊时癌症分期更晚。关于这些差异是否因社会经济劣势和地理偏远程度而异，现有证据相互矛盾。本研究调查了澳大利亚新南威尔士州（NSW）这些差异的变化情况。
方法
从新南威尔士州癌症登记处提取了2000 - 2008年确诊癌症的数据（n = 264,219）。对缺失的原住民身份信息（13.3%）进行了多重填补。采用逻辑回归和竞争风险回归模型，按社会经济劣势（分为五分位数1：最不劣势 - 5：最劣势）和偏远程度，研究原住民与非原住民相比处于晚期总结分期的可能性以及癌症死亡风险。
结果
在社会经济劣势和偏远程度类别中，与非原住民相比，原住民在确诊时总体呈现出癌症分期更晚的模式。在调整了人口因素、确诊年份、总结分期和癌症部位后，生活在最不劣势地区以外的原住民与生活在类似地区的非原住民相比，癌症死亡风险增加（五分位数2 - 5的亚风险比SHR分别为1.41，95%置信区间CI 1.09 - 1.81；SHR 1.59，95%CI 1.31 - 1.93；SHR 1.42，95%CI 1.22 - 1.64和SHR 1.34，95%CI 1.22 - 1.48）。与非原住民相比，无论偏远程度如何，原住民的癌症死亡风险都有所升高，在偏远/非常偏远地区升高最为明显（SHR 1.56，95%CI 1.10 - 2.21）。
结论
与非原住民相比，在社会经济劣势和偏远程度类别中，原住民的癌症死亡风险更高，处于更晚期的可能性更大。在努力改善原住民癌症生存结果方面，所有地区似乎都需要关注。
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