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Cancer Causes & Control

, Volume 21, Issue 2, pp 209–214 | Cite as

Determinants of inequalities in cervical cancer stage at diagnosis and survival in New Zealand

  • Patricia PriestEmail author
  • Lynn Sadler
  • Peter Sykes
  • Roger Marshall
  • Julia Peters
  • Sue Crengle
Original paper

Abstract

Objective

The aim of this study is to assess whether ethnic inequalities in cervical cancer mortality are due to differences in survival independent of stage and age at diagnosis, and to assess the contribution of screening to stage at diagnosis.

Methods

Demographic data and cervical screening history were collected for 402 women with histologically proven primary invasive cervical cancer, diagnosed in New Zealand between 1 January 2000 and 30 September 2002. Date of death was available for women who died up to 30 September 2004.

Results

A Cox proportional hazard model showed that, after adjusting for age, the Māori mortality rate was 1.80 times (95% CI 1.07–3.04) that of non-Māori. This reduced to 1.25 (95% CI 0.74–2.11) when stage at diagnosis was also adjusted for. Among determinants of late stage at diagnosis, older age and being Māori significantly increased the risk, while screening was protective.

Conclusions

These results indicate that later stage at diagnosis is the main determinant of Māori women’s higher mortality from cervical cancer. Improving cervical screening among Māori women would reduce stage at diagnosis and therefore ethnic inequalities in mortality.

Keywords

Health status disparities Cervical cancer Survival 

Notes

Acknowledgments

This study uses data from the New Zealand Cervical Cancer Audit, which was funded by the New Zealand Ministry of Health (MoH) and carried out as a partnership between the MoH and UniServices Ltd, University of Auckland. The authors thank Drs Charlotte Paul, Brian Cox and Mary-Jane Sneyd for helpful comments on earlier drafts of this article; Ruth Herbert and Dr. William Rainger who managed the project; Sandra Coney, Dr. Peter Bethwaite, Dr. Gabriele Medley, and Harold Neal who provided expert advice to the project; Rachel Brown, Claire Macdonald, Orewa Barrett-Ohia, Charlotte Bergman, and Rhondda Kerins who performed the interviews; and Catherine Dick, Stephanie Smith, Kirstine Sutton, and Sarah Sparks who abstracted the medical records data.

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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Patricia Priest
    • 1
    Email author
  • Lynn Sadler
    • 2
  • Peter Sykes
    • 3
  • Roger Marshall
    • 4
  • Julia Peters
    • 5
  • Sue Crengle
    • 6
  1. 1.Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
  2. 2.National Women’s Health, Auckland District Health BoardAucklandNew Zealand
  3. 3.Department of Obstetrics and GynaecologyUniversity of OtagoChristchurchNew Zealand
  4. 4.Section of Epidemiology and Biostatistics, School of Population HealthUniversity of AucklandAucklandNew Zealand
  5. 5.Auckland Regional Public Health Service, Auckland District Health BoardAucklandNew Zealand
  6. 6.Department of Māori Health, School of Population HealthUniversity of AucklandAucklandNew Zealand

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