Sociodemographics and 10-year prostate cancer survival data

The issue of sociodemographic inequality in the delivery of cancer care is well understood in America — and we don’t really know how to provide a high quality of care to those who are disadvantaged by economic factors, racial factors, or other demographic factors (such a rural vs. urban issues of access to care).

It is therefore interesting to see that, even though Australia has a nationalized healthcare system, that, in theory, offers equal access to care for all of its population, many of the same sociodemographic issues can be observed in the delivery of prostate cancer care as are observed in America.

Yu et al. looked at factors affecting the social and geographic variation in prostate cancer survival in the Australian state of New South Wales over the past 20 years. And New South Wales is the most populated state in Australia, with a total population of > 7 million (out of a total Australian population of > 23 million).

The authors sought to do two things:

  • To assess whether a reported urban-rural differential in prostate cancer survival in New South Wales remained after adjusting for demographic and clinical factors
  • To investigate changes in this differential over time

To do this, they conducted a retrospective, population-based analysis of the survival times of 68,686 men diagnosed with prostate cancer between January 1982 and December 2007. The primary outcome measures were (a) actual survival rates and (b) relative excess risk (RER) for death during a 10-year follow-up period in relation to “geographic remoteness” (i.e., distance from a major urban center) — after making appropriate adjustments for key diagnostic factors.

Here are their core findings:

  • The 10-year overall survival increased during the study period
    • From 57.5 percent in 1992-1996 to
    • 75.7 percent in 1997-2001 to
    • 83.7 percent in 2002-2007.
  • These trends occurred across categories of geographic remoteness and socioeconomic status.
  • Urban-rural differentials were significant (P < 0.001) after adjusting for five important prognostic factors.
  • Men living outside major cities had a higher risk of death from prostate cancer than those living closer to such cities (compared to those actually living within major urban centers).
    • RER = 1.18 for inner regional areas.
    • RER = 1.32 for rural areas.
  • Socioeconomic status was also important (P < 0.001).
    • Compared to men living in the least socioeconomically disadvantaged areas, men diagnosed with prostate cancer and living in more socially disadvantaged areas were 34 to 40 percent more likely to die of prostate cancer.
  • There was no evidence that these inequities have changed over time, particularly for men living in inner regional areas.

The overall improvement in 10-year prostate cancer-specific mortality rates in Australia since 1982 are likely attributable to earlier diagnosis as well as to improvements in treatment over the past 30 years (just as they are in America). However, it is clear from these data that, just as in America, certain types of inequity do significantly impact risk for prostate cancer-specific diagnosis and death.

Yu et al. conclude that:

Despite the increasing awareness of urban-rural differentials in cancer outcomes, little progress has been made. Appropriately detailed data, including details of tumour characteristics, treatment and comorbid conditions, to help understand why these inequalities exist are required urgently so interventions and policy changes can be guided by appropriate evidence.

Even though America and Australia have very different forms of healthcare system, the “access to care factors” affect diagnosis and treatment for prostate cancer in America are by no means restricted to this counrty, but can be seen even in some countries that have made the idea of equal access to care a core premise of their healthcare systems.


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