Cancer survival in New South Wales, Australia: socioeconomic disparities remain despite overall improvements

Abstract

Background: Disparities in cancer survival by socioeconomic status have been reported previously in Australia. We investigated whether those disparities have changed over time.

Methods: We used population-based cancer registry data for 377,493 patients diagnosed with one of 10 major cancers in New South Wales (NSW), Australia. Patients were assigned to an area-based measure of socioeconomic status. Five-year relative survival was estimated for each socioeconomic quintile in each 'at risk' period (1996-2000 and 2004-2008) for the 10 individual cancers. Poisson-regression modelling was used to adjust for several prognostic factors. The relative excess risk of death by socioeconomic quintile derived from this modelling was compared over time.

Results: Although survival increased over time for most individual cancers, Poisson-regression models indicated that socioeconomic disparities continued to exist in the recent period. Significant socioeconomic disparities were observed for stomach, colorectal, liver, lung, breast and prostate cancer in 1996-2000 and remained so for 2004-2008, while significant disparities emerged for cervical and uterus cancer in 2004-2008 (although the interaction between period and socioeconomic status was not significant). About 13.4% of deaths attributable to a diagnosis of cancer could have been postponed if this socioeconomic disparity was eliminated.

Conclusion: While recent health and social policies in NSW have accompanied an increase in cancer survival overall, they have not been associated with a reduction in socioeconomic inequalities.

Fig. 1

Relative excess risk* by socioeconomic disadvantage for 10 cancers in New South Wales, Australia, 1996–2000 and 2004–2008. ^*The RER of the reference group (least disadvantaged SES quintile) was set to 1.00