Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia.
School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
Cancer Causes Control. 2023 Jan;34(1):13-22. doi: 10.1007/s10552-022-01643-1. Epub 2022 Oct 20.
In Australia, Aboriginal and Torres Strait Islander peoples (First Nations population) often have low overall cancer survival, as do all residents of geographically remote areas. This study aimed to quantify the survival disparity between First Nations and other Queenslanders for 12 common cancer types by remoteness areas.
For all Queensland residents aged 20-89 years diagnosed with a primary invasive cancer during 1997-2016, we ran flexible parametric survival models incorporating age, First Nations status, sex, diagnosis time period, area-level socioeconomic status, remoteness categories and where appropriate, broad cancer type. Three survival measures were predicted: cause-specific survival, survival differences and the comparative survival ratio, each standardised to First Nations peoples' covariate distributions.
The standardised five-year cause-specific cancer survival was 60% for urban First Nations and 65% for other Queenslanders, while remote residents were 54% (First Nations) and 58% (other). The absolute survival differential between First Nations and other Queenslanders was often similar, regardless of remoteness of residence. The greatest absolute difference in five-year standardised cancer survival was for head and neck cancers, followed by cervical cancer. The five-year comparative survival ratio (First Nations: other Queenslanders) for urban cancer patients was 0.91 (95% CI 0.90-0.93), similar to outer regional, inner regional and remote areas. The greatest comparative survival differential was for oesophageal cancer.
First Nations' survival inequalities are largely independent of geographical remoteness. It remains a priority to determine the contribution of other potential factors such as the availability of culturally acceptable diagnostic, management and/or support services.
在澳大利亚，原住民和托雷斯海峡岛民（第一民族人口）的整体癌症存活率通常较低，居住在地理位置偏远地区的所有人的存活率也较低。本研究旨在通过偏远地区量化第一民族和昆士兰州其他居民 12 种常见癌症类型的生存差异。
对于在 1997 年至 2016 年间被诊断患有原发性浸润性癌症的所有 20-89 岁昆士兰州居民，我们运行了灵活参数生存模型，其中包含年龄、第一民族身份、性别、诊断时间段、地区级社会经济状况、偏远地区类别以及在适当情况下，广泛的癌症类型。预测了三种生存指标：特定原因的生存、生存差异和比较生存比，每个指标都按照第一民族人民的协变量分布进行标准化。
城市第一民族的五年特定原因癌症生存率为 60%，其他昆士兰州人为 65%，而偏远地区居民为 54%（第一民族）和 58%（其他）。第一民族和其他昆士兰州人之间的绝对生存差异通常相似，无论居住地的偏远程度如何。五年标准化癌症生存率的最大绝对差异是头颈部癌症，其次是宫颈癌。城市癌症患者的五年比较生存比（第一民族：其他昆士兰州人）为 0.91（95%CI 0.90-0.93），与远郊、内城和偏远地区相似。最大的比较生存差异是食管癌。
第一民族的生存不平等在很大程度上独立于地理位置的偏远程度。仍然需要优先确定其他潜在因素（如文化上可接受的诊断、管理和/或支持服务的可用性）的贡献。
