Geographic variation in prostate cancer survival in New South Wales, Australia
METHODS: The study sample comprised men diagnosed with prostate cancer from January 1982 to December 2007 and resident in New South Wales (NSW), Australia. The outcome measure was 10-year relative survival ratio. To adjust for other prognostic factors, a relative survival model was used with relative excess risk (RER) of death being the outcome variable.
RESULTS: Over the study period, the 10-year relative survival ratio increased from 57.5% in 1992-1996, to 75.7% in 1997-200, and then to 83.7% in 2002-2007. Increasing trends were also observed across categories of geographic remoteness and socioeconomic status. There were, however, significant differences by geographic remoteness (p<0.001) after adjusting for five important prognostic factors. Men living outside major cities had a higher risk of death from prostate cancer (RER=1.21 (95% CI: 1.12-1.30) for inner regional and RER=1.32 (95% CI: 1.19-1.46) for rural areas). Over time this difference in survival has marginally increased (p=0.052), particularly for men living in inner regional areas. Socioeconomic status was also significantly associated with prostate cancer mortality (p<0.001). The risk of death from prostate cancer was higher for men living in the most disadvantaged (RER=1.41) and middle disadvantaged areas (RER=1.34) compared with the least disadvantaged areas.
CONCLUSIONS: Despite the increasing awareness that where you live can affect your cancer outcomes, there has been little progress made in reducing the geographic inequity in prostate cancer mortality in this Australian state over the last two decades. Detailed data that helps explain why these inequalities exist are required, so that interventions and policy changes can be guided by appropriate evidence.