Differentials in survival for childhood cancer in Australia by remoteness of residence and area disadvantage
Cette étude en population australienne (6 289 participants) évalue les disparités socio-économiques et géographiques dans la survie de patients pédiatriques atteints de cancer
Background: It is not known whether improvements in cancer survival over recent decades have benefited children from different geographical locations equally. This is the first study to produce national survival estimates for childhood cancer in Australia by remoteness of residence and area-based socioeconomic status. Methods: The study utilised population-based data from the Australian Paediatric Cancer Registry for children diagnosed with cancer from 1996 onwards who were at risk of mortality between January 2001 and December 2006 (n = 6289). Remoteness was specified according to the Australian Standard Geographical Classification Remoteness Areas, while an index of area disadvantage was obtained from census information. Five-year relative survival estimates were produced by the period method for all cancers and the most common diagnostic groups, with corresponding age-sex adjusted mortality hazard ratios calculated using Poisson regression. Results: Overall, children with cancer from remote/very remote areas had a significantly lower survival rate than their counterparts in major cities (HR = 1.55; 95% CI = 1.08-2.23). Survival was also lower for children with leukaemia living in inner regional (HR = 1.52; 95% CI = 1.11-2.08) or outer regional areas (HR = 1.53; 95% CI = 1.03-2.28). There was weak evidence (p = 0.051) of a trend towards poorer survival by greater area disadvantage for all childhood cancers. Conclusions: Some variation in prognosis by place of residence was present for children with cancer in Australia, particularly among leukaemia patients. Impact: Treatment, clinical or area-related factors that contribute to these survival differentials need to be identified.