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. 2012 May 6:12:168.
doi: 10.1186/1471-2407-12-168.

Estimates of cancer incidence, mortality and survival in aboriginal people from NSW, Australia

Stephen Morrell  1 , Hui You, Deborah Baker
Affiliations

Estimates of cancer incidence, mortality and survival in aboriginal people from NSW, Australia

Stephen Morrell et al. BMC Cancer. .

Abstract

Background: Aboriginal status has been unreliably and incompletely recorded in health and vital registration data collections for the most populous areas of Australia, including NSW where 29% of Australian Aboriginal people reside. This paper reports an assessment of Aboriginal status recording in NSW cancer registrations and estimates incidence, mortality and survival from cancer in NSW Aboriginal people using multiple imputation of missing Aboriginal status in NSW Central Cancer Registry (CCR) records.

Methods: Logistic regression modelling and multiple imputation were used to assign Aboriginal status to those records of cancer diagnosed from 1999 to 2008 with missing Aboriginality (affecting 12-18% of NSW cancers registered in this period). Estimates of incidence, mortality and survival from cancer in NSW Aboriginal people were compared with the NSW total population, as standardised incidence and mortality ratios, and with the non-Aboriginal population.

Results: Following imputation, 146 (12.2%) extra cancers in Aboriginal males and 140 (12.5%) in Aboriginal females were found for 1999-2007. Mean annual cancer incidence in NSW Aboriginal people was estimated to be 660 per 100,000 and 462 per 100,000, 9% and 6% higher than all NSW males and females respectively. Mean annual cancer mortality in NSW Aboriginal people was estimated to be 373 per 100,000 in males and 240 per 100,000 in females, 68% and 73% higher than for all NSW males and females respectively. Despite similar incidence of localised cancer, mortality from localised cancer in Aboriginal people is significantly higher than in non-Aboriginal people, as is mortality from cancers with regional, distant and unknown degree of spread at diagnosis. Cancer survival in Aboriginal people is significantly lower: 51% of males and 43% of females had died of the cancer by 5 years following diagnosis, compared to 36% and 33% of non-Aboriginal males and females respectively.

Conclusion: The present study is the first to produce valid and reliable estimates of cancer incidence, survival and mortality in Australian Aboriginal people from NSW. Despite somewhat higher cancer incidence in Aboriginal than in non-Aboriginal people, substantially higher mortality and lower survival in Aboriginal people is only partly explained by more advanced cancer at diagnosis.

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Figures

Figure 1
Figure 1
Proportion (%) of Aboriginal status missing in NSW cancer registrations by alive/dead status of cancer case.
Figure 2
Figure 2
Inpatient admission episodes and proportion (%) of Aboriginal status missing in alive cancer cases, 1999-2007.
Figure 3
Figure 3
Age-specific cancer incidence and mortality, per 100,000 Aboriginal and non-Aboriginal males and females, NSW, 1999-2007.
Figure 4
Figure 4
Age-standardised cancer incidence and mortality by degree of spread at diagnosis, Aboriginals and non-Aboriginals, males and females, 1999-2007.
Figure 5
Figure 5
Survival from cancer in Aboriginals and non-Aboriginals, persons, males and females, 1999-2007.
See this image and copyright information in PMC

References

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