Background Reducing disparities in cancer outcomes is a major priority for cancer-control agencies. The authors examine the relationships between geographic remoteness, area disadvantage and risk of advanced breast cancer among women.
Methods Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced breast cancer among women aged 30–79 years diagnosed as having breast cancer in Queensland, Australia between 1997 and 2006 (n=18 658).
Results Women who resided in the most socio-economically disadvantaged areas were significantly more likely (OR 1.21, 95% CI 1.07 to 1.37) than residents of the most advantaged areas to be diagnosed as having advanced breast cancer after adjustment for individual-level factors. When geographic remoteness and area-disadvantage (and all the individual-level factors) were simultaneously adjusted, the rates of advanced breast cancer were significantly higher for women residing in Outer Regional areas (OR 1.13, 95% CI 1.02 to 1.24) and those who lived in the most disadvantaged areas (OR 1.16, 95% CI 1.02 to 1.32). There was no statistically significant interaction between geographic remoteness and area disadvantage.
Conclusions A woman's risk of being diagnosed as having advanced breast cancer depends on where she lives, separate from the individual characteristics of the woman herself. Both the rurality and socio-economic characteristics of the geographical area in which women lived were important. The socio-economic factors contributing to advanced breast cancer, existing in both urban and rural environments, need to be investigated.
- Breast cancer
- multilevel modelling
- inequalities SI
- epidemiology ME
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Funding This study was partially supported by a grant from the (Australian) National Health and Medical Research Council (NHMRC) (ID: 561700). GT is supported by a NHMRC Senior Research Fellowship (ID 390109).
Competing interests None.
Ethics approval Ethics approval was provided by the University of Queensland Social and Behavioral Sciences Ethical Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.