A population-based study in New South Wales 1980-2009 Socio-demographic disadvantage has been found to relate to generally lower cancer survival . Population-based studies of associations with cancer stage have been less frequent. The aim of this study was to examine the associations between distant summary stage of cancer at diagnosis and socio-economic status, geographic remoteness, and country of birth in New South Wales (NSW) overall and by cancer sites.

1. Working together to lessen the impact of cancer
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Socio-demographic factors and summary
stage of cancer at diagnosis
– a population-based study in New South Wales in 1980-2009
Adjusted model1
(1980-2009)
OR (95%CI)
Stratified2
1980-89
OR (95%CI)
1990-99
OR (95%CI)
2000-09
OR (95%CI)
Interaction
P value3
Place of Residence X2
(3)
p=0.034
Major cities 1 1 1 1
Inner regional 0.90 (0.88-0.91) 0.89 (0.86-0.93) 0.89 (0.86-0.91) 0.91 (0.88-0.93)
Outer regional 0.92 (0.89-0.94) 0.89 (0.85-0.94) 0.91 (0.87-0.95) 0.93 (0.90-0.97)
Remote/Very remote 1.08 (0.99-1.18) 1.14 (0.96-1.36) 1.11 (0.95-1.30) 1.04 (0.91-1.18)
SEIFA quintile X2
(4)
p<0.001
1 (least disadvantaged) 1 1 1 1
2 1.18 (1.16-1.20) 1.12 (1.08-1.17) 1.17 (1.13-1.21) 1.22 (1.18-1.26)
3 1.20 (1.17-1.22) 1.11 (1.07-1.16) 1.20 (1.15-1.24) 1.25 (1.21-1.30)
4 1.21 (1.18-1.23) 1.15 (1.10-1.20) 1.21 (1.16-1.26) 1.25 (1.21-1.29)
5 (most disadvantaged) 1.27 (1.24-1.30) 1.14 (1.09-1.18) 1.22 (1.18-1.27) 1.40 (1.35-1.45)
Country of birth X2
(3)
p<0.001
Australia 1 1 1 1
Other English speaking 1.10 (1.07-1.12) 1.05 (1.01-1.09) 1.09 (1.05-1.13) 1.15 (1.11-1.18)
Non-English speaking 1.12 (1.10-1.14) 1.04 (1.00-1.08) 1.13 (1.10-1.17) 1.15 (1.12-1.18)
Unknown 0.20 (0.19-0.21) 0.45 (0.41-0.50) 0.16 (0.15-0.18) 0.18 (0.17-0.19)
OR: Odds ratio, SEIFA: Socio-economic index for areas.
1 Adjusted for gender, age, diagnostic period and disadvantage predictor variables.
2 Adjusted for gender, age and disadvantage predictor variables.
3 P value for the interaction between predictor variable and year of diagnosis including all cases diagnosed in 1980-09.
Hanna Tervonen1
, Richard Walton2
, David Roder1,2
, Hui You2
, Stephen Morrell2
, Deborah Baker2
, Sanchia Aranda2
. For questions contact: hanna.tervonen@unisa.edu.au
1 School of Health Sciences, University of South Australia, Adelaide SA, Australia
2 Cancer Institute NSW, Sydney NSW, Australia
Introduction & aims
Socio-demographic disadvantage has been found to relate to generally lower cancer survival [1,2]. Population-based studies of associations
with cancer stage have been less frequent.
The aim of this study was to examine the associations between distant summary stage of cancer at diagnosis and socio-economic status,
geographic remoteness, and country of birth in New South Wales (NSW) overall and by cancer sites.
Methods
The population-based New South Wales Cancer
Registry (NSWCR) data were used for invasive
cancers diagnosed in 1980-2009 (n=699,382).
The NSWCR routinely collects summary stage
at diagnosis for solid tumours, classified as
localised, regional, distant or unknown.
Logistic regression models were used to
compute odds ratios (OR) with 95% confidence
intervals (CI) for distant compared with other
stage at diagnosis.
Conclusions
Living in socio-economically disadvantaged areas was comparatively the strongest predictor of distant stage at diagnosis.
Actions are needed to encourage early detection of cancer in all socio-economic strata.
Figure 1. Proportion of cases diagnosed with distant stage cancer by SEIFA quintile,
NSW Cancer Registry 1980-2009.
.22
.2
.18
.16
.14
.12
1980 1990 2000 2010
Proportionofcaseswithdistantstage
Year of diagnosis
.22
.2
.18
.16
.14
.12
1980 1990 2000
Proportionofcaseswithdistantstage
Year of diagnosis
Table 1. Associations between disadvantage predictor variables and diagnosis of distant cancer,
NSW Cancer Registry 1980-2009.
Results
Living in the most socio-economically
disadvantaged areas (OR 1.27, 95%CI 1.24-1.30),
and being born outside Australia, both in English
(OR 1.10, 95%CI 1.07-1.12) and non-English
speaking countries (OR 1.12, 95%CI 1.10-1.14)
were associated with distant stage at diagnosis
(Table 1).
In cancer site specific analyses, living in socio-
economically disadvantaged areas was generally
the strongest predictor of distant stage and it was
associated with distant stage of stomach,
colorectal, melanoma, female breast, prostate
and bladder cancers.
Difference in the proportion of cases with distant
stage increased over time between the most
compared with the least disadvantaged areas
(Figure 1).
SEIFA quintile 1
SEIFA quintile 2
SEIFA quintile 3
SEIFA quintile 4
SEIFA quintile 5
REFERENCES 1 Woods et al., Ann Oncol. 17 (2006) 5-19. 2Yu et al., Cancer Causes Control. 19 (2008) 1383-90.
ACKNOWLEDGEMENTS Cancer Institute NSW. National Health and Medical Research Council Program Grant 0631946. University of South Australia.