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Cancer Causes & Control

, Volume 19, Issue 2, pp 183–193 | Cite as

Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis

  • Rebecca Bentley
  • Anne Marie Kavanagh
  • S. V. Subramanian
  • Gavin Turrell
Original Paper

Abstract

Objective

To examine associations between area and individual socio-economic characteristics and premature cancer mortality using multilevel analysis.

Methods

We modeled cancer mortality among 25–64-year-old men and women (n = 16,340) between 1998 and 2000 in Australia. Socio-economic characteristics of Statistical Local Areas (n = 1,317) were measured using an Index of Relative Socio-economic Disadvantage (quintiles), and individual socio-economic position was measured by occupation (professionals, white and blue collar).

Results

After adjustment for within-area variation in age and occupation, the probability of premature cancer mortality was highest in the most disadvantaged areas for all-cancer mortality for men (RR 1.48 95% CI 1.35–1.63) and women (RR 1.30 95% CI 1.18–1.43) and for lung cancer mortality for men (1.91 95% CI 1.63–2.25) and women (1.51 95% CI 1.04–2.18).

Men in blue collar occupations had a higher rate of cancer mortality (RR 1.57 95% CI 1.50–1.65) and lung cancer mortality (RR 2.31 95 % CI 2.09–2.56), whereas men in white collar occupations had a lower all-cancer mortality rate (RR 0.78 95% CI 0.72–0.85). Compared with professionals, women in white collar occupations had an all-cancer mortality rate that was lower (RR 0.85 95% CI 0.80–0.90). When deaths from breast cancer were excluded, women in blue collar occupations had a significantly higher all-cancer mortality rate than professionals (RR 1.12 95% CI 1.02–1.22).

Conclusions

Area disadvantage and individual socio-economic position were independently associated with premature cancer mortality, suggesting that interventions to reduce inequalities should focus on places and people.

Keywords

Cancer Mortality Socio-economic factors Socio-economic status Australia 

Notes

Acknowledgements

R. Bentley is supported by a National Health and Medical Research Council Capacity Building Grant in Population. Health Research (Australian Health Inequalities: A program addressing social and economic determinants of health). S. V. Subramanian is supported by the National Institutes of Health Career Development Award (NHLBI 1 K25 HL081275). Gavin Turrell is supported by a National Health and Medical Research Council Senior Research Fellowship (No. 390109).

References

  1. 1.
    Faggiano F, Lemma P, Costa G, Gnavi R, Pagnanelli F (1995) Cancer mortality by educational level in Italy. Cancer Causes and Control 6(4):311–320PubMedCrossRefGoogle Scholar
  2. 2.
    Marshall B, Chevalier A, Garillon C, Goldberg M, Coing F (1999) Socioeconomic status, social mobility and cancer occurrence during working life: a case-control study among French Electricity and Gas Workers. Cancer Causes and Control 10(6):495–502PubMedCrossRefGoogle Scholar
  3. 3.
    Martikainen P (1995) Mortality and socio-economic status among Finnish women. Population Studies 49(1):71–90CrossRefGoogle Scholar
  4. 4.
    Greenwald HP, Borgotta EF, McCorkle R, Polissar N (1996) Explaining reduced cancer survival among the disadvantaged. Milbank Q 74(2):215–238PubMedCrossRefGoogle Scholar
  5. 5.
    Hall S, Holman CD, Platell C, Shneier H, Threlfall T, Semmens J (2005) Colorectal cancer surgical care and survival: do private health insurance, socio-economic and locational status make a difference? ANZ J Surg 75(11):929–35PubMedCrossRefGoogle Scholar
  6. 6.
    Hall S, Holman CD, Sheiner H, Hendrie D (2004) The influence of socio-economic and locational disadvantage on survival after a diagnosis of lung or breast cancer in Western Australia. J Health Serv Res Policy 9(Supplement 2):10PubMedCrossRefGoogle Scholar
  7. 7.
    Hall S, Holman CD, Wisniewski Z, Semmens J (2005) Prostate cancer: socio-economic, geographical and private-health insurance effects on care and survival. BJU Int 95(1):51–8PubMedCrossRefGoogle Scholar
  8. 8.
    Kravdal O (2000) Social inequalties in cancer survival. Popul Stud 54(1):1–18CrossRefGoogle Scholar
  9. 9.
    Mandelblatt J, Andrews H, Kao R, Wallace R, Kerner J (1996) The late-stage diagnosis of colorectal cancer: demographic and socio-economic factors. Am J Public Health 86(12):1794–7PubMedGoogle Scholar
  10. 10.
    Vinnakota S, Lam NSN (2006) Socio-economic inequality of cancer mortality in the United States: a spatial data mining approach. Int J Health Geogr 15 Feb 2006(5): 9Google Scholar
  11. 11.
    U.S. Cancer Statistics Working Group (2005) United States cancer statistics: 2002 incidence and mortality. U.S. Department of Health and Human Services, Centres for Disease Control and Prevention, National Cancer Institute, AtlantaGoogle Scholar
  12. 12.
    Speigel D, Bloom JR, Kraemer HC, Gottheil E (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 2:888–891CrossRefGoogle Scholar
  13. 13.
    Singh GK, A. MB, Hankey BF, Edwards BK (2003) Area socioeconomic variations in U.S. cancer incidence, mortality, stage, treatment and survival, 1975–1999. NIH publication no. 04-5417. National Cancer Institute, Bethesda, MDGoogle Scholar
  14. 14.
    Australian Institute of Health and Welfare and Australasian Association of Cancer Registries (2007) Cancer in Australia: an overview, 2006. Cancer series no. 37. AIHW, CanberraGoogle Scholar
  15. 15.
    Draper G, Turrell G, Oldenburg B (2004) Health inequalities in Australia: mortality. Health Inequalities Monitoring Series No. 1 AIHW cat. no. PHE 55. Queensland University of Technology and the Australian Institute of Health and Welfare, CanberraGoogle Scholar
  16. 16.
    Piantadosi S, Byar D, Green S (1988) The ecological fallacy. Am J Epidemiol 127:893–904PubMedGoogle Scholar
  17. 17.
    Robert S, Strombom I, Trentham-Dietz A, Hampton J, McElroy J, Newcomb P, Remington P (2004) Socioeconomic risk factors for breast cancer: distinguishing individual- and community-level effects. Epidemiology 15(4):442–450PubMedCrossRefGoogle Scholar
  18. 18.
    Steenland K, Henley J, Calle E, Thun M (2004) Individual- and area-level socioeconomic status variables as predictors in mortality in a cohort of 179,383 persons. Am J Epidemiol 159(11):1047–1056PubMedCrossRefGoogle Scholar
  19. 19.
    Waitzman N, Smith K (1998) Phantom of the area: poverty-area residence and mortality in the United States. Am J Public Health 88:973–976PubMedGoogle Scholar
  20. 20.
    Subramanian S, Duncan C, Jones K (2001) Multilevel perspectives on modeling census data. Environ Plan A 33:399–417CrossRefGoogle Scholar
  21. 21.
    Harvard Center for Cancer Prevention (1996) Harvard Reports on Cancer Prevention: human causes of cancer. Cancer Causes Control 7(Supplement 1):533–535Google Scholar
  22. 22.
    Australian Institute of Health, Welfare (2004) Cancer in Australia 2001. Cancer series number 28. Australian Institute of Health and Welfare, CanberraGoogle Scholar
  23. 23.
    Smith D, Taylor R, Coates M (1996) Socioeconomic differentials in cancer incidence and mortality in urban New South Wales, 1987–1991. Aust N Z J Public Health 20(2):129–137PubMedCrossRefGoogle Scholar
  24. 24.
    Australian Institute of Health, Welfare & National Breast Cancer Centre (2006) Breast cancer in Australia: an overview, 2006. Cancer series no. 34. AIHW, CanberraGoogle Scholar
  25. 25.
    Australian Bureau of Statistics (1996) Statistical geography: volume 1 Australian Standard Geographical Classification (ASGC). Australian Government Publishing Service, CanberraGoogle Scholar
  26. 26.
    Magliano D, Liew D, Pater H, Kirby A, Hunt D, Simes J, Sundararajan V, Tonkin A (2003) Accuracy of the Australian National Death Index: comparison with adjudicated fatal outcomes among Australian participants in the Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Aust N Z J Public Health 27(6):649–53PubMedCrossRefGoogle Scholar
  27. 27.
    Australian Bureau of Statistics (1997) Australian Standard Classification of Occupations, 2nd edn. Australian Government Publishing Service, CanberraGoogle Scholar
  28. 28.
    Australian Bureau of Statistics (1998) Socioeconomic index for areas. Australian Government Publishing Service, CanberraGoogle Scholar
  29. 29.
    Bennett S (1996) Socioeconomic inequality in coronary heart disease and stroke mortality among Australian men. Int J Epidemiol 25:266–75PubMedCrossRefGoogle Scholar
  30. 30.
    Burton N, Turrell G (2000) Occupation, hours worked, and leisure-time physical activity. Prev Med 31:673–81PubMedCrossRefGoogle Scholar
  31. 31.
    Goldstein H (2003) Multilevel statistical models. Arnold, LondonGoogle Scholar
  32. 32.
    Rasbash J, Browne W, Goldstein H (2000) A user’s guide to MLwiN version 2.1. Institute of Education, The University of London, LondonGoogle Scholar
  33. 33.
    Turrell G, Mathers C (2000) Socio-economic status and health in Australia. Med J Aust 172:434–438PubMedGoogle Scholar
  34. 34.
    Blais S, Dejardin O, Boutreaux S, Launoy G (2006) Social determinants of access to reference care centres for patients with colorectal cancer—a multilevel analysis. Eur J Cancer 42(17):3041–8PubMedCrossRefGoogle Scholar
  35. 35.
    Parsons M, Askland K (2007) Cancer of the colorectum in Maine, 1995–1998: determinants of stage at diagnosis in a rural state. J Rural Health 23(1):25–32PubMedCrossRefGoogle Scholar
  36. 36.
    The World Health Organisation. (2002) The world health report: reducing risks, promoting healthy life. WHO, GenevaGoogle Scholar
  37. 37.
    Kavanagh A, Goller J, King T, Jolley D, Crawford D, Turrell G (2005) Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia. J Epidemiol Community Health 59:934–940PubMedCrossRefGoogle Scholar
  38. 38.
    van Lenthe F, Brug J, Mackenbach J (2005) Neighbourhood inequalities in physical inactivity: the role of neighbourhood attractiveness, proximity to local facilities and safety in the Netherlands. Soc Sci Med 60(4):763–775PubMedCrossRefGoogle Scholar
  39. 39.
    Glass T, Rasmussen M, Schwartz M (2006) Neighbourhoods and obesity in older adults. The Baltimore memory study. Am J Prev Med 31(6):455–463PubMedCrossRefGoogle Scholar
  40. 40.
    Shaw H, McGovern V, Milton G, Farago G (1981) Cutaneous malignant melanoma: occupational and prognosis. Med J Aust 1(1):37–8PubMedGoogle Scholar
  41. 41.
    Schwartz K, Crossley-May H, Vigneau F, Brown K, Banerjee M (2003) Race, socioeconomic status and stage at diagnosis for five common malignancies. Cancer Causes Control 14(8):761–6PubMedCrossRefGoogle Scholar
  42. 42.
    Australian Institute of Health, Welfare (2006) Australia’s health 2006. AIHW cat. no. AUS 73. AIHW, CanberraGoogle Scholar
  43. 43.
    Morris M, Iacopetta B, Platell C (2007) Comparing survival outcomes for patients with colorectal cancer treated in public and private hospitals. Med J Aust 186(6):296–300PubMedGoogle Scholar
  44. 44.
    Turrell G, Kavanagh A, Draper G, Subramanian SV (2007) Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000. J Epidemiol Community Health 61(1):13–19PubMedCrossRefGoogle Scholar
  45. 45.
    Blakely T, Fawcett J (2005) Bias measuring mortality gradients by occupational class in New Zealand. N Z Med J 118:U1253PubMedGoogle Scholar
  46. 46.
    Turrell G, Hewitt B, Patterson C (2003) Measuring socioeconomic position in dietary research: is choice of socioeconomic indicator important? Public Health Nutr 6:191–200PubMedCrossRefGoogle Scholar
  47. 47.
    Boyle MH, Wilms JD (1999) Place effects for areas defined by administrative boundaries. Am J Epidemiol 149:577–585PubMedGoogle Scholar
  48. 48.
    Curtis S, Jones I (1998) Is there a place for geography in the analysis of health inequality? Sociol Health Illn 20:645–672CrossRefGoogle Scholar
  49. 49.
    Martikainen P, Valkonen T (1999) Bias related to the exclusion of the economically inactive in studies on social class differences in mortality. Int J Epidemiol 28:899–904PubMedCrossRefGoogle Scholar
  50. 50.
    Harper S, Lynch J (2005) Methods for measuring cancer disparities: using data relevant to Health People 2010 cancer-related objectives. NCI cancer surveillance monograph series. National Cancer Institute, US Department of Health and Human Services, National Institute of Health, Washington, DCGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Rebecca Bentley
    • 1
  • Anne Marie Kavanagh
    • 1
  • S. V. Subramanian
    • 2
  • Gavin Turrell
    • 3
  1. 1.Key Center for Women’s Health in Society, School of Population HealthUniversity of MelbourneMelbourneAustralia
  2. 2.Department of Society, Human Development and HealthHarvard School of Public HealthBostonUSA
  3. 3.School of Public HealthQueensland University of TechnologyBrisbaneAustralia

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