Peter Baade

Geographical Disparities in Screening and Cancer-Related Health Behaviour

This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014–2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.

Temporal and area-level variation in prevalence of high-grade histologically confirmed cervical abnormalities among Indigenous and non-Indigenous women, Queensland, Australia, 2008–2017

Objective Despite Australia’s National Cervical Screening Program, Indigenous women have a disproportionately high burden of cervical cancer. We describe temporal and area-level patterns in prevalence of histologically conformed high-grade cervical abnormalities (hHGA) among cytologically screened women by Indigenous status. Methods This was a population-based study of 2,132,925 women, aged 20–69, who underwent cervical screening between 2008 and 2017, in Queensland, Australia. Of these, 47,136 were identified as Indigenous from linked hospital records. Overall patterns in hHGA prevalence by Indigenous status were quantified using prevalence rate ratios (PrRR) from negative binomial models. Bayesian spatial models were used to obtain smoothed prevalence estimates of hHGA across 528 small areas compared to the state average. Results are presented as maps and graphs showing the associated uncertainty of the estimates. Results Overall, screened Indigenous women had significantly higher hHGA prevalence than non-Indigenous women. However, the magnitude of the difference reduced over time ( p  < 0.001). Adjusted for age and area-level variables, Indigenous women had 36% higher hHGA prevalence (PrRR 1.36, 95% confidence interval [1.21–1.52]) than non-Indigenous women between 2013 and 2017. The overall effect of age decreased over time ( p  = 0.021). Although there was evidence of moderate spatial variation in 10-year prevalence estimates for both groups of women, the high levels of uncertainty for many estimates, particularly for Indigenous women, limited our ability to draw definitive conclusions about the spatial patterns. Conclusions While the temporal reduction in Indigenous: non-Indigenous differential in hHGA prevalence is encouraging, further research into the key drivers of the continuing higher risk among Indigenous women is warranted.

Cancer Incidence in Migrants in Australia: Patterns of Three Infection-Related Cancers

Abstract Background: Australia provides an ideal population-base for cancer migration studies because of its multicultural society and high-quality cancer registrations. Among migrant groups there is considerable variability in the incidence of infection-related cancers; thus, the patterns of three such cancers were examined among migrant groups relative to Australian-born residents. Methods: Using national incidence data for cancers of the stomach, liver, and cervix diagnosed during 2005 to 2014, incidence rates were compared for selected migrant groups with the Australian-born population using incidence rate ratios (IRR), from a negative binomial regression model. Results: Wide variations in incidence between countries/regions of birth were observed for all three cancers (P < 0.0001). The patterns were similar for cancers of the stomach and liver, in that migrants from countries/regions with higher incidence rates maintained an increased risk in Australia, with the highest being among South American migrants (IRR = 2.35) for stomach cancer and among Vietnamese migrants (5.44) for liver cancer. In contrast, incidence rates of cervical cancer were lower for many migrant groups, with women from Southern Asia (0.39) and North Africa (0.42) having the lowest rates. The rate of cervical cancer was higher in migrants from New Zealand, Philippines, and Polynesia. Conclusions: Several Australian migrant groups were found to experience a disproportionate burden of infection-related cancers; further studies of associated risk factors may inform the design of effective interventions to mediate these disparities. Impact: By identifying these migrant groups, it is hoped that these results will motivate and inform prevention or early detection activities for these migrant groups. See related commentary Dee and Gomez, p. 1251