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Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry

Abstract

Purpose

Cancer survival is generally lower for rural compared with urban residents, but findings have been inconsistent. We aimed to assess inequalities in cancer survival by remoteness of residence in Victoria, Australia.

Methods

Incident cancer cases diagnosed in 2001–2015 with 30 cancer types (n = 331,302) were identified through the Victorian Cancer Registry and followed to the end of 2015 through death registries. Five-year net survival was estimated using the Pohar–Perme method and differences assessed by excess mortality rate ratios (EMRRs) using Poisson regression, adjusting for sex, age and year of diagnosis. EMRRs adjusted for socio-economic disadvantage were also estimated.

Results

People living outside major cities had lower survival for 11 cancers: esophagus, stomach, colorectum, liver, gallbladder/biliary tract, pancreas, lung, connective/soft tissue, ovary, prostate, kidney. No differences in survival were found for cancers of uterus, small intestine and mesothelioma. After adjusting for socio-economic disadvantage, the observed differences in survival decreased for most cancers and disappeared for colorectal cancer, but they remained largely unchanged for cancers of esophagus, stomach, liver, pancreas, lung, connective/soft tissue, ovary and kidney.

Conclusion

People with cancer residing outside major cities had lower survival from some cancers, which is partly due to the greater socio-economic disadvantage of rural residents.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. N.A. is the recipient of an Australian Government Research Training Program Scholarship.

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Correspondence to Nina Afshar.

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Ethical approval to conduct the analyses of these data was granted by the Cancer Council Victoria Human Research Ethics Committee. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Afshar, N., English, D.R., Chamberlain, J.A. et al. Differences in cancer survival by remoteness of residence: an analysis of data from a population-based cancer registry. Cancer Causes Control 31, 617–629 (2020). https://doi.org/10.1007/s10552-020-01303-2

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  • DOI: https://doi.org/10.1007/s10552-020-01303-2

Keywords

  • Rural
  • Urban
  • Inequalities
  • Cancer survival
  • Excess mortality
  • Survival analysis