Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study

Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Brisbane, QLD 4004, Australia.
British Journal of Cancer (Impact Factor: 4.82). 09/2011; 105(7):1039-41. DOI: 10.1038/bjc.2011.356
Source: PubMed

ABSTRACT We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer.
Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced disease among people aged 20-79 years diagnosed with colorectal cancer in Queensland, Australia between 1997 and 2007 (n=18,561).
Multilevel analysis showed that colorectal cancer patients living in inner regional (OR=1.09, 1.01-1.19) and outer regional (OR=1.11, 1.01-1.22) areas were significantly more likely to be diagnosed with advanced cancer than those in major cities (P=0.045) after adjusting for individual-level variables. The best-fitting final model did not include area disadvantage. Stratified analysis suggested this remoteness effect was limited to people diagnosed with colon cancer (P=0.048) and not significant for rectal cancer patients (P=0.873).
Given the relationship between stage and survival outcomes, it is imperative that the reasons for these rurality inequities in advanced disease be identified and addressed.

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    • "Studies from other western countries have provided only limited and inconsistent findings (Coughlin et al., 2006; Clegg et al., 2009; Donnelly and Gavin, 2011). However, numerous studies have suggested that disadvantaged individuals and/or those living far from a reference cancer centre or in remote areas could have poorer access to CRC screening and to specialized healthcare, or could be more prone to an advanced stage at diagnosis leading to a worse prognosis (Dejardin et al., 2005; Blais et al., 2006; Parikh-Patel et al., 2006; Dejardin et al., 2008; Von Wagner et al., 2009; Jambon et al., 2010; Lejeune et al., 2010; Baade et al., 2011; Hines et al., 2014). "
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