Ethnic disparities in breast cancer survival in New Zealand: which factors contribute?

BMC Cancer

Vernon Harvey¹  Diana Sarfati²  Sanjeewa Seneviratne³  Ross Lawrenson⁴  Charis Brown⁵  Sandar Tin Tin⁶  J. Mark Elwood⁶  Reena Ramsaroop⁷  Ian Campbell⁸  Nina Scott⁹ 

[1] Auckland District Health Board;Department of Public Health, The University of Otago;Department of Surgery, The University of Colombo;National Institute of Demographic and Economic Analysis, The University of Waikato;SMART Marketing and Research;Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland;Surgical Pathology Department, Waitemata District Health Board;Waikato Clinical Campus, The University of Auckland;Waikato District Health Board;

关键词: Breast cancer;    Survival;    Ethnic groups;    Mediation;    New Zealand;   

DOI  :  10.1186/s12885-017-3797-0

来源: DOAJ

【 摘 要 】

Abstract Background New Zealand has major ethnic disparities in breast cancer survival with Māori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential. Methods This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Māori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Māori and Pacific patients were assessed. Results Of the 13,657 patients who were included in this analysis, 1281 (9.4%) were Māori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51–2.04 for Māori and 1.97; 95% CI: 1.67–2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy. Conclusions Late diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Māori and Pacific women.

【 授权许可】

Unknown