Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study
Menée en Australie entre 1997 et 2007 auprès de 18 561 patients agés de 20 à 79 ans, cette étude analyse les disparités géographiques, entre zones rurales et urbaines, dans le stade au diagnostic d'un cancer colorectal
We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer. Methods: 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). Results: 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). Conclusion: 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.