A multilevel study of the determinants of area-level inequalities in colorectal cancer survival

Journal article

Baade, Peter D., Turrell, Gavin and Aitken, Joanne F.. (2010). A multilevel study of the determinants of area-level inequalities in colorectal cancer survival. BMC Cancer. 10(1), p. Article 24. https://doi.org/10.1186/1471-2407-10-24
AuthorsBaade, Peter D., Turrell, Gavin and Aitken, Joanne F.
Abstract

Background
In Australia, associations between geographic remoteness, socioeconomic disadvantage, and colorectal cancer (CRC) survival show that survival rates are lowest among residents of geographically remote regions and those living in disadvantaged areas. At present we know very little about the reasons for these inequalities, hence our capacity to intervene to reduce the inequalities is limited.

Methods/Design
This study, the first of its type in Australia, examines the association between CRC survival and key area- and individual-level factors. Specifically, we will use a multilevel framework to investigate the possible determinants of area- and individual-level inequalities in CRC survival and quantify the relative contribution of geographic remoteness, socioeconomic and demographic factors, disease stage, and access to diagnostic and treatment services, to these inequalities. The multilevel analysis will be based on survival data relating to people diagnosed with CRC in Queensland between 1996 and 2005 (n = 22,723) from the Queensland Cancer Registry (QCR), area-level data from other data custodians such as the Australian Bureau of Statistics, and individual-level data from the QCR (including extracting stage from pathology records) and Queensland Hospitals. For a subset of this period (2003 and 2004) we will utilise more detailed, individual-level data (n = 1,966) covering a greater range of risk factors from a concurrent research study. Geo-coding and spatial technology will be used to calculate road travel distances from patients' residence to treatment centres. The analyses will be conducted using a multilevel Cox proportional hazards model with Level 1 comprising individual-level factors (e.g. occupation) and level 2 area-level indicators of remoteness and area socioeconomic disadvantage.

Discussion
This study focuses on the health inequalities for rural and disadvantaged populations that have often been documented but poorly understood, hence limiting our capacity to intervene. This study utilises and develops emerging statistical and spatial technologies that can then be applied to other cancers and health outcomes. The findings of this study will have direct implications for the targeting and resourcing of cancer control programs designed to reduce the burden of colorectal cancer, and for the provision of diagnostic and treatment services.

Year2010
JournalBMC Cancer
Journal citation10 (1), p. Article 24
PublisherBioMed Central
ISSN1471-2407
Digital Object Identifier (DOI)https://doi.org/10.1186/1471-2407-10-24
PubMed ID20109230
Scopus EID2-s2.0-77649285189
PubMed Central IDPMC2837617
Open accessPublished as ‘gold’ (paid) open access
Page range1-8
FunderNational Health and Medical Research Council (NHMRC)
Cancer Council Queensland
Research GroupInstitute for Health and Ageing
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online28 Jan 2010
Publication process dates
Accepted28 Jan 2010
Grant ID561700
390109
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Individual and household-level socioeconomic position is associated with harmful alcohol consumption behaviours among adults
Giskes, Katrina, Turrell, Gavin, Bentley, Rebecca and Kavanagh, Anne. (2011). Individual and household-level socioeconomic position is associated with harmful alcohol consumption behaviours among adults. Australian and New Zealand Journal of Public Health. 35(3), pp. 270 - 277. https://doi.org/10.1111/j.1753-6405.2011.00683.x
Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: A cross-sectional, multilevel study
Baade, Peter D., Turrell, Gavin and Aitken, Joan F.. (2011). Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: A cross-sectional, multilevel study. Journal of Epidemiology and Community Health. 65(11), pp. 1037 - 1043. https://doi.org/10.1136/jech.2010.114777
The association between sedentary leisure and physical activity in middle-aged adults
Burton, Nicola W., Khan, Asaduzzaman, Brown, Wendy J. and Turrell, Gavin. (2011). The association between sedentary leisure and physical activity in middle-aged adults. British Journal of Sports Medicine. 46, pp. 747 - 752. https://doi.org/10.1136/bjsm.2010.081430
Test-retest reliability of perceptions of the neighborhood environment for physical activity by socioeconomic status
Turrell, Gavin, Haynes, Michele A., O'Flaherty, Martin, Burton, Nicola W., Giskes, Katrina, Giles-Corti, Billie and Wilson, Lee-Ann. (2011). Test-retest reliability of perceptions of the neighborhood environment for physical activity by socioeconomic status. Journal of Physical Activity and Health. 8(6), pp. 829 - 840. https://doi.org/10.1123/jpah.8.6.829
Perceived weight status may contribute to education inequalities in five-year weight change among mid-aged women
Siu, Jessica, Giskes, Katrina, Shaw, Jonathan and Turrell, Gavin. (2011). Perceived weight status may contribute to education inequalities in five-year weight change among mid-aged women. Australian and New Zealand Journal of Public Health. 35, pp. 284 - 291. https://doi.org/10.1111/j.1753-6405.2010.00705.x
Traditional birth attendant training and local birthing practices in India
Saravanan, Sheela, Turrell, Gavin, Johnson, Helen, Fraser, Jenny and Patterson, Carla. (2011). Traditional birth attendant training and local birthing practices in India. Evaluation and Program Planning. 34(3), pp. 254 - 265. https://doi.org/10.1016/j.evalprogplan.2011.02.012
Birthing practices of traditional birth attendants in South Asia in the context of training programmes
Saravanan, Sheela, Turrell, Gavin, Johnson, Helen and Fraser, Jennifer. (2010). Birthing practices of traditional birth attendants in South Asia in the context of training programmes. Journal of Health Management. 12(2), pp. 93 - 121. https://doi.org/10.1177/097206341001200201
Associations among smoking status, lifestyle and lipoprotein subclasses
Beauchamp, Allison, Tonkin, Andrew, Peeters, A, Wolfe, R, Turrell, Gavin, Harriss, Linton, Giles, Graham G., English, Dallas and Jenkins, Alicia J.. (2010). Associations among smoking status, lifestyle and lipoprotein subclasses. Journal of Clinical Lipidology. 4(6), pp. 522 - 530. https://doi.org/10.1016/j.jacl.2010.09.003
Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors.
Beauchamp, Allison, Peeters, A., Wolfe, R., Turrell, Gavin, Harriss, Linton, Giles, Graham G., English, Dallas, McNeil, John, Magliano, Dianna J., Harrap, Stephen, Liew, Danny, Hunt, David and Tonkin, Andrew. (2010). Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors. Journal of Epidemiology and Community Health. 64(6), pp. 542 - 548. https://doi.org/10.1136/jech.2009.094516
Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes
Kavanagh, Anne M., Bentley, Rebecca J., Turrell, Gavin, Shaw, J. E., Dunstan, David and Subramanian, S V.. (2010). Socioeconomic position, gender, health behaviours and biomarkers of cardiovascular disease and diabetes. Social Science & Medicine. 71(6), pp. 1150 - 1160. https://doi.org/10.1016/j.socscimed.2010.05.038
Neighborhood Disadvantage and Physical Activity: Baseline Results from the HABITAT Multilevel Longitudinal Study
Turrell, Gavin, Haynes, Michele A., Burton, Nicola W., Giles-Corti, Billie, Oldenburg, Brian, Wilson, Lee-Ann, Giskes, Katrina and Brown, Wendy. (2010). Neighborhood Disadvantage and Physical Activity: Baseline Results from the HABITAT Multilevel Longitudinal Study. Annals of Epidemiology. 20(3), pp. 171 - 181. https://doi.org/10.1016/j.annepidem.2009.11.004
Best practice for prevention and treatment of cardiovascular disease through an equity lens: A review
Beauchamp, Allison, Peeters, A., Tonkin, Andrew and Turrell, Gavin. (2010). Best practice for prevention and treatment of cardiovascular disease through an equity lens: A review. European Journal of Preventative Cardiology. 17(5), pp. 599 - 606. https://doi.org/10.1097/HJR.0b013e328339cc99
HABITAT: A longitudinal multilevel study of physical activity change in mid-aged adults
Burton, Nicola W., Haynes, Michele A., Wilson, Lee-Ann, Giles-Corti, Billie, Oldenburg, Brian, Brown, Wendy, Giskes, Katrina and Turrell, Gavin. (2009). HABITAT: A longitudinal multilevel study of physical activity change in mid-aged adults. BMC Public Health. 9(1). https://doi.org/10.1186/1471-2458-9-76
A multilevel study of area socio-economic status and food purchasing behaviour
Turrell, Gavin, Bentley, Rebecca, Thomas, Lyndal R., Jolley, Damien, Subramanian, S. V. and Kavanagh, Anne M.. (2009). A multilevel study of area socio-economic status and food purchasing behaviour. Public Health Nutrition. 12(11), pp. 2074-2083. https://doi.org/10.1017/S1368980009004911
Socioeconomic differences in takeaway food consumption and their contribution to inequalities in dietary intakes
Miura, Kyoko, Giskes, Katrina and Turrell, Gavin. (2009). Socioeconomic differences in takeaway food consumption and their contribution to inequalities in dietary intakes. Journal of Epidemiology and Community Health. 63(10), pp. 820 - 826. https://doi.org/10.1136/jech.2008.086504
Social roles and birthing practices of traditional birth attendants in India with reference to other developing countries
Saravanan, Sheela, Johnson, Helen, Turrell, Gavin and Fraser, Jennifer. (2009). Social roles and birthing practices of traditional birth attendants in India with reference to other developing countries. Asian Journal of Women's Studies. 15(4), pp. 57 - 89. https://doi.org/10.1080/12259276.2009.11666078
Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia
Zhang, Jianzhen, Oldenburg, Brian and Turrell, Gavin. (2009). Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia. BMC Health Services Research. 9(1). https://doi.org/10.1186/1472-6963-9-218
Affluent neighborhoods reduce excess risk of tooth loss among the poor
Sanders, Anne E., Turrell, Gavin and Slade, Gary D.. (2008). Affluent neighborhoods reduce excess risk of tooth loss among the poor. Journal of Dental Research. 87(10), pp. 969 - 973. https://doi.org/10.1177/154405910808701006
Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: A longitudinal study with 13-year follow-up
Giskes, Katrina, van Lenthe, Frank J., Turrell, Gavin, Kamphuis, Carlijn B. M., Brugemann, Johan and Mackenbach, Johan P.. (2008). Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: A longitudinal study with 13-year follow-up. Obesity. 16(6), pp. 1377 - 1381. https://doi.org/10.1038/oby.2008.54
Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: A multilevel analysis
Bentley, Rebecca J., Kavanagh, Anne M., Subramanian, S. V. and Turrell, Gavin. (2008). Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: A multilevel analysis. Cancer Causes and Control. 19(2), pp. 183 - 193. https://doi.org/10.1007/s10552-007-9084-7
Socioeconomic disadvantage and the purchase of takeaway food: A multilevel analysis
Turrell, Gavin and Giskes, Katrina. (2008). Socioeconomic disadvantage and the purchase of takeaway food: A multilevel analysis. Appetite. 51(1), pp. 69 - 81. https://doi.org/10.1016/j.appet.2007.12.002
Area variation in recreational cycling in Melbourne: A compositional or contextual effect?
Kamphuis, Carlijn B. M., Giskes, Katrina, Kavanagh, Anne M., Thornton, Lukar, Thomas, Lyndal R., van Lenthe, Frank J., Mackenbach, Johan P. and Turrell, Gavin. (2008). Area variation in recreational cycling in Melbourne: A compositional or contextual effect? Journal of Epidemiology and Community Health. 62(10), pp. 890 - 898. https://doi.org/10.1136/jech.2007.067116
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
Turrell, Gavin, Kavanagh, Anne M., Draper, Glenn and Subramanian, S V.. (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. Journal of Epidemiology and Community Health. 61(1), pp. 13 - 19. https://doi.org/10.1136/jech.2006.046094
Measuring psychological, social, and environmental influences on leisure-time physical activity among adults
Burton, Nicola W., Turrell, Gavin, Oldenburg, Brian and Sallis, Jim. (2007). Measuring psychological, social, and environmental influences on leisure-time physical activity among adults. Australian and New Zealand Journal of Public Health. 31(1), pp. 36 - 43. https://doi.org/10.1111/j.1753-6405.2007.00008.x
The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: A multilevel analysis
Turrell, Gavin, Sanders, Anne E., Slade, Gary D., Spencer, A John and Marcenes, Wagner. (2007). The independent contribution of neighborhood disadvantage and individual-level socioeconomic position to self-reported oral health: A multilevel analysis. Community Dentistry and Oral Epidemiology. 35(3), pp. 195 - 206. https://doi.org/10.1111/j.1600-0528.2006.00311.x
Socioeconomic inequalities in food purchasing: The contribution of respondent-perceived and actual (objectively measured) price and availability of foods
Giskes, Katrina, van Lenthe, Frank J., Mackenbach, Johan P. and Turrell, Gavin. (2007). Socioeconomic inequalities in food purchasing: The contribution of respondent-perceived and actual (objectively measured) price and availability of foods. Preventive Medicine. 45(1), pp. 41 - 48. https://doi.org/10.1016/j.ypmed.2007.04.007
Does psychological stress mediate social deprivation in tooth loss?
Sanders, Anne E., Slade, Gary D., Turrell, Gavin, Spencer, A John and Marcenes, Wagner. (2007). Does psychological stress mediate social deprivation in tooth loss? Journal of Dental Research. 86(12), pp. 1166 - 1170. https://doi.org/10.1177/154405910708601205
Socioeconomic disadvantage in childhood and across the life course and all-cause mortality and physical function in adulthood: Evidence from the Alameda County Study
Turrell, Gavin, Lynch, John, Leite, Claudia, Raghunathan, Trivellore and Kaplan, George A.. (2007). Socioeconomic disadvantage in childhood and across the life course and all-cause mortality and physical function in adulthood: Evidence from the Alameda County Study. Journal of Epidemiology and Community Health. 61(8), pp. 723 - 730. https://doi.org/10.1136/jech.2006.050609
Smokers living in deprived areas are less likely to quit: A longitudinal follow-up
Giskes, Katrina, van Lenthe, Frank J., Turrell, Gavin, Brugemann, Johan and Mackenbach, Johan P.. (2006). Smokers living in deprived areas are less likely to quit: A longitudinal follow-up. Tobacco Control. 15(6), pp. 485 - 488. https://doi.org/10.1136/tc.2006.015750
Weight and place: A multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia
King, Tania, Kavanagh, Anne M., Jolley, Damien, Turrell, Gavin and Crawford, David. (2006). Weight and place: A multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia. International Journal of Obesity. 30(2), pp. 281 - 287. https://doi.org/10.1038/sj.ijo.0803176
Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane food study
Winkler, Elizabeth A. H., Turrell, Gavin and Patterson, Carla. (2006). Does living in a disadvantaged area mean fewer opportunities to purchase fresh fruit and vegetables in the area? Findings from the Brisbane food study. Health and Place. 12(3), pp. 306 - 319. https://doi.org/10.1016/j.brainresbull.2006.01.003
A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population : The GLoBE study
Giskes, Katrina, Turrell, Gavin, van Lenthe, Frank J., Brugemann, Johan and Mackenbach, Johan P.. (2006). A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population : The GLoBE study. Public Health Nutrition. 9(1), pp. 75-83. https://doi.org/10.1079/PHN2005758
Does gender modify associations between self rated health and the social and economic characteristics of local environments?
Kavanagh, Anne M., Bentley, Rebecca J., Turrell, Gavin, Broom, Dorothy H. and Subramanian, S V.. (2006). Does gender modify associations between self rated health and the social and economic characteristics of local environments? Journal of Epidemiology and Community Health. 60(6), pp. 490 - 495. https://doi.org/10.1136/jech.2005.043562
Area variation in mortality in Tasmania (Australia): The contributions of socioeconomic disadvantage, social capital and geographic remoteness
Turrell, Gavin, Kavanagh, Anne M. and Subramanian, S. V.. (2006). Area variation in mortality in Tasmania (Australia): The contributions of socioeconomic disadvantage, social capital and geographic remoteness. Health and Place. 12(3), pp. 291 - 305. https://doi.org/10.1016/j.healthplace.2004.08.012
Socio-economic pathways to diet: Modelling the association between socio-economic position and food purchasing behaviour
Turrell, Gavin and Kavanagh, Anne M.. (2006). Socio-economic pathways to diet: Modelling the association between socio-economic position and food purchasing behaviour. Public Health Nutrition. 9(3), pp. 375 - 383. https://doi.org/10.1079/PHN2006850
Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania
Kavanagh, Anne M., Turrell, Gavin and Subramanian, S. V.. (2006). Does area-based social capital matter for the health of Australians? A multilevel analysis of self-rated health in Tasmania. International Journal of Epidemiology. 35(3), pp. 607 - 613. https://doi.org/10.1093/ije/dyl010
The shape of the socioeconomic-oral health gradient: Implications for theoretical explanations
Sanders, Anne E., Slade, Gary D., Turrell, Gavin, Spencer, A John and Marcenes, Wagner. (2006). The shape of the socioeconomic-oral health gradient: Implications for theoretical explanations. Community Dentistry and Oral Epidemiology. 34(4), pp. 310 - 319. https://doi.org/10.1111/j.1600-0528.2006.00286.x
Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study
Winkler, Elizabeth A. H., Turrell, Gavin and Patterson, Carla. (2006). Does living in a disadvantaged area entail limited opportunities to purchase fresh fruit and vegetables in terms of price, availability, and variety? Findings from the Brisbane Food Study. Health and Place. 12(4), pp. 741 - 748. https://doi.org/10.1016/j.healthplace.2005.09.006
Urban area disadvantage and physical activity: A multilevel study in Melbourne, Australia
Kavanagh, Anne M., Goller, Jane L., King, Tania, Jolley, Damien, Crawford, David and Turrell, Gavin. (2005). Urban area disadvantage and physical activity: A multilevel study in Melbourne, Australia. Journal of Epidemiology and Community Health. 59(11), pp. 934 - 940. https://doi.org/10.1136/jech.2005.035931
Childhood and Adult Socioeconomic Conditions and 31-Year Mortality Risk in Women
Beene-Dimmer, Jennifer, Lynch, John, Turrell, Gavin, Lustgarten, Stephanie, Raghunathan, Trivellore and Kaplan, George A.. (2004). Childhood and Adult Socioeconomic Conditions and 31-Year Mortality Risk in Women. American Journal of Epidemiology. 159(5), pp. 481 - 490. https://doi.org/10.1093/aje/kwh057
Utilisation of general practitioner services by socio-economic disadvantage and geographic remoteness
Turrell, Gavin, Oldenburg, Brian, Harris, Elizabeth and Jolley, Damien. (2004). Utilisation of general practitioner services by socio-economic disadvantage and geographic remoteness. Australian and New Zealand Journal of Public Health. 28(2), pp. 152 - 158. https://doi.org/10.1111/j.1467-842X.2004.tb00929.x
A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour
Turrell, Gavin, Blakely, Tony, Patterson, Carla and Oldenburg, Brian. (2004). A multilevel analysis of socioeconomic (small area) differences in household food purchasing behaviour. Journal of Epidemiology and Community Health. 58(3), pp. 208-215. https://doi.org/10.1136/jech.2003.011031