Objective To investigate which factors account for the ethnic disparities in stage at diagnosis and cervical cancer survival in New Zealand.
Methods The study involved 1594 cervical cancer cases registered during 1994–2005. Logistic regression was used to estimate adjusted ORs for late stage diagnosis. Cox regression was used to estimate adjusted cervical cancer mortality HRs.
Results Māori and Pacific women had a higher risk of late stage diagnosis compared with “Other” (predominantly European) women with adjusted ORs of 2.71 (1.98 to 3.72) and 1.39 (0.76 to 2.54) respectively. The excess risk in Māori women fell by 19% when adjusted for screening history, and travel time to the nearest general practitioner and cancer centre; the excess risk in Pacific women fell by 85% when adjusted for the same factors. The survival HRs for Māori and Pacific women were 2.10 (1.61 to 2.73) and 1.96 (1.23 to 3.13) respectively; these fell by 59% and 43% respectively when adjusted for stage at diagnosis, comorbidities, and travel time.
Conclusions There are major ethnic differences in cervical cancer stage at diagnosis and cervical cancer survival in New Zealand. The excess risk of late stage diagnosis in Māori women remains largely unexplained, whereas that in Pacific women is almost entirely due to differences in screening history and travel time. About one-half of the excess risk of mortality in Māori and Pacific women is explained by differences in stage at diagnosis and comorbidities; it is possible that other factors, including possible differences in treatment and follow-up, may also play a role.
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