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Remoteness, race and social disadvantage: disparities in hepatocellular carcinoma incidence and survival in Queensland, Australia
Author(s) -
Clark Paul J.,
Stuart Katherine A.,
Leggett Barbara A.,
Crawford Darrell H.,
Boyd Peter,
Fawcett Jonathan,
Whiteman David C.,
Baade Peter D.
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12853
Subject(s) - demography , incidence (geometry) , medicine , population , hepatocellular carcinoma , epidemiology , residence , cancer registry , survival analysis , proportional hazards model , environmental health , physics , sociology , optics
Background & Aims Incidence and mortality of hepatocellular carcinoma ( HCC ) is increasing globally, but varies between countries and regions. To target scarce resources to most need, clinical services must be informed by regional epidemiology. Using population‐based data, we sought to document the incidence and mortality of HCC in Queensland, Australia, a state occupying a vast land area with diverse at‐risk subpopulations. Methods Using population‐based data from 1996 to 2011, the age‐standardised incidence rate ( ASR ), annual percentage change ( APC ) and survival of HCC in Queensland were assessed with negative binomial regression, Kaplan–Meier and Cox survival analysis. Spatial patterns of HCC incidence and survival and relevant predictors were mapped. Results Thousand six hundred and twenty HCC s were diagnosed during this study period, with an overall ASR of 2.00‐cases/1000 population. ASR increased by 3.5% per year, (95% CI : 2.1 to 5.0), P < 0.001) among males to 5.6/100,000 in 2011 and a non‐significant increase of 2.6% per year, (95% CI = −0.7 to 6.0), P = 0.111) among females to 1.6/100,000 in 2011. Higher incidence was associated with male gender, older age, major city residence and proportionally higher area Indigenous population. Thousand and two hundred and eighty‐seven patients died. Median survival was approximately 10 months. Five‐year survival improved from 18% in 1996–2000 to 24% in 2006–2011 ( P < 0.001). Poorer survival was associated with older age, less recent period of diagnosis, lower hepatitis B prevalence in country of origin and greater area‐level social disadvantage. Conclusions Over this study period, HCC incidence increased significantly. HCC survival improved but remains poor. Social determinants are critical to HCC epidemiology.