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      Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia

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          Public concerns are commonly expressed about widening health gaps. This cohort study examines variations and trends in cancer survival by socio-economic disadvantage, geographical remoteness and country of birth in an Australian population over a 30-year period.


          Data for cases diagnosed in New South Wales (NSW) in 1980–2008 ( n = 651,245) were extracted from the population-based NSW Cancer Registry. Competing risk regression models, using the Fine & Gray method, were used for comparative analyses to estimate sub-hazard ratios (SHR) with 95% confidence intervals (CI) among people diagnosed with cancer.


          Increased risk of cancer death was associated with living in the most socio-economically disadvantaged areas compared with the least disadvantaged areas (SHR 1.15, 95% CI 1.13–1.17), and in outer regional/remote areas compared with major cities (SHR 1.05, 95% CI 1.03–1.06). People born outside Australia had a similar or lower risk of cancer death than Australian-born (SHR 0.99, 95% CI 0.98–1.01 and SHR 0.91, 95% CI 0.90–0.92 for people born in other English and non-English speaking countries, respectively). An increasing comparative risk of cancer death was observed over time when comparing the most with the least socio-economically disadvantaged areas (SHR 1.07, 95% CI 1.04–1.10 for 1980–1989; SHR 1.14, 95% CI 1.12–1.17 for 1990–1999; and SHR 1.24, 95% CI 1.21–1.27 for 2000–2008; p < 0.001 for interaction between disadvantage quintile and year of diagnosis).


          There is a widening gap in comparative risk of cancer death by level of socio-economic disadvantage that warrants a policy response and further examination of reasons behind these disparities.

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          Most cited references 29

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          Explaining trends in inequities: evidence from Brazilian child health studies.

          There is considerable international concern that child-health inequities seem to be getting worse between and within richer and poorer countries. The "inverse equity hypothesis" is proposed to explain how such health inequities may get worse, remain the same, or improve over time. We postulate that as new public-health interventions and programmes initially reach those of higher socioeconomic status and only later affect the poor, there are early increases in inequity ratios for coverage, morbidity, and mortality indicators. Inequities only improve later when the rich have achieved new minimum achievable levels for morbidity and mortality and the poor gain greater access to the interventions. The hypothesis was examined using three epidemiological data sets for time trends in child-health inequities within Brazil. Time trends for inequity ratios for morbidity and mortality, which were consistent with the hypothesis, showed both improvements and deterioration over time, despite the indicators showing absolute improvements in health status between rich and poor.
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            Origins of socio-economic inequalities in cancer survival: a review.

            Cancer survival is known to vary by socio-economic group. A review of studies published by 1995 showed this association to be universal and resilient to the many different ways in which socio-economic status was determined. Differences were most commonly attributed to differences in stage of disease at diagnosis. A review of research published since 1995 examining the association of cancer survival with socio-economic variables. An association between socio-economic status and cancer survival has continued to be demonstrated in the last decade of research. Stage at diagnosis and differences in treatment have been cited as the most important explanatory factors. Some research has evaluated the psychosocial elements of this association. Socio-economic differences in cancer survival are now well documented. The explanatory power of stage at diagnosis, although great, should not detract from the evidence of differential treatment between social groups. Neither factor can completely explain the observed socio-economic differences in survival, however, and the importance of differences in tumour and patient factors should now be quantified.
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              Cancer Disparities by Race/Ethnicity and Socioeconomic Status


                Author and article information

                +61 8 8302 0437 , hanna.tervonen@unisa.edu.au
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                14 September 2017
                14 September 2017
                : 17
                [1 ]ISNI 0000 0000 8994 5086, GRID grid.1026.5, School of Health Sciences, Centre for Population Health Research, University of South Australia, ; GPO Box 2471, Adelaide, SA 5001 Australia
                [2 ]ISNI 0000 0001 1887 3422, GRID grid.427695.b, Cancer Institute NSW, ; GPO Box 41, Alexandria, Sydney, NSW 1435 Australia
                [3 ]ISNI 0000 0001 0944 0844, GRID grid.453998.a, Cancer Council Australia, ; GPO Box 4708, Sydney, NSW 2001 Australia
                [4 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Public Health and Community Medicine, University of New South Wales, UNSW, ; Sydney, 2052 Australia
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: 0631946
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                Research Article
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                © The Author(s) 2017


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