Higher Comorbidity Burden does not Explain Lower Survival for Indigenous Australian Women with Cervical Cancer

A. Diaz, P. Baade, P. C. Valery, L. J. Whop, S. P. Moore, J. Cunningham, G. Garvey, J. Brotheton, D. L. O'Connell, K. Canfell, D. Sarfati, D. Roder, E. Buckley, J. R. Condon

    Research output: Contribution to journalMeeting AbstractResearch

    Abstract

    Background: We aimed to investigate the effect of comorbidity on cervical cancer survival for Australian women, and whether it contributed to the excess mortality of Indigenous Australian women compared to non‐Indigenous women.


    Method: Cervical cancer cases diagnosed 2003–2012 in six Australian states/territories (covering 96% of the Australian female population) were linked to hospital inpatient records for the identification of comorbidity data. The weighted Charlson comorbidity index was calculated and categorised as a score 0 (no comorbidity), 1 or 2+. Kaplan Meier 5‐year cause‐specific survival probabilities were calculated by Indigenous status and comorbidity level. Flexible parametric survival models were used to model excess mortality by comorbidity score, for Indigenous and non‐Indigenous women. The effect of comorbidity on cancer stage at diagnosis was also investigated for a sub‐group of women from NSW, for whom staging data was available.


    Results: 4,467 Australian women (4.4% Indigenous) with cervical cancer were included. Indigenous women were younger and had more comorbidity at diagnosis (score ≥1 24% vs. 10%, respectively). Indigenous women had lower survival than non‐Indigenous women (60% vs. 77%). After adjustment for study factors, increased comorbidity was clearly associated with increased mortality for non‐Indigenous women, but not for Indigenous women. Stratified analysis showed that the survival disparity between Indigenous women and non‐Indigenous women was contained to those without comorbidity (HR 2.5, 95%CI 1.9‐3.4). Indigenous and non‐Indigenous women with comorbidity had similar survival.


    Conclusion: The difference in survival for Indigenous and non‐Indigenous women without comorbidity warrants further investigation and may reflect differences in how health services engage these women.

    Original languageEnglish
    Article number92
    Pages (from-to)92-93
    Number of pages2
    JournalAsia-Pacific Journal of Clinical Oncology
    Volume13
    Issue numberS4
    DOIs
    Publication statusPublished - 1 Nov 2017

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    Uterine Cervical Neoplasms
    Comorbidity
    Survival
    Women's Health Services
    Mortality
    Hospital Records
    Inpatients
    Neoplasms

    Cite this

    Diaz, A. ; Baade, P. ; Valery, P. C. ; Whop, L. J. ; Moore, S. P. ; Cunningham, J. ; Garvey, G. ; Brotheton, J. ; O'Connell, D. L. ; Canfell, K. ; Sarfati, D. ; Roder, D. ; Buckley, E. ; Condon, J. R. / Higher Comorbidity Burden does not Explain Lower Survival for Indigenous Australian Women with Cervical Cancer. In: Asia-Pacific Journal of Clinical Oncology. 2017 ; Vol. 13, No. S4. pp. 92-93.
    @article{95b9d898f8c441a3b8c252617d309922,
    title = "Higher Comorbidity Burden does not Explain Lower Survival for Indigenous Australian Women with Cervical Cancer",
    abstract = "Background: We aimed to investigate the effect of comorbidity on cervical cancer survival for Australian women, and whether it contributed to the excess mortality of Indigenous Australian women compared to non‐Indigenous women. Method: Cervical cancer cases diagnosed 2003–2012 in six Australian states/territories (covering 96{\%} of the Australian female population) were linked to hospital inpatient records for the identification of comorbidity data. The weighted Charlson comorbidity index was calculated and categorised as a score 0 (no comorbidity), 1 or 2+. Kaplan Meier 5‐year cause‐specific survival probabilities were calculated by Indigenous status and comorbidity level. Flexible parametric survival models were used to model excess mortality by comorbidity score, for Indigenous and non‐Indigenous women. The effect of comorbidity on cancer stage at diagnosis was also investigated for a sub‐group of women from NSW, for whom staging data was available. Results: 4,467 Australian women (4.4{\%} Indigenous) with cervical cancer were included. Indigenous women were younger and had more comorbidity at diagnosis (score ≥1 24{\%} vs. 10{\%}, respectively). Indigenous women had lower survival than non‐Indigenous women (60{\%} vs. 77{\%}). After adjustment for study factors, increased comorbidity was clearly associated with increased mortality for non‐Indigenous women, but not for Indigenous women. Stratified analysis showed that the survival disparity between Indigenous women and non‐Indigenous women was contained to those without comorbidity (HR 2.5, 95{\%}CI 1.9‐3.4). Indigenous and non‐Indigenous women with comorbidity had similar survival. Conclusion: The difference in survival for Indigenous and non‐Indigenous women without comorbidity warrants further investigation and may reflect differences in how health services engage these women.",
    keywords = "Oncology",
    author = "A. Diaz and P. Baade and Valery, {P. C.} and Whop, {L. J.} and Moore, {S. P.} and J. Cunningham and G. Garvey and J. Brotheton and O'Connell, {D. L.} and K. Canfell and D. Sarfati and D. Roder and E. Buckley and Condon, {J. R.}",
    year = "2017",
    month = "11",
    day = "1",
    doi = "10.1111/ajco.12798",
    language = "English",
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    Higher Comorbidity Burden does not Explain Lower Survival for Indigenous Australian Women with Cervical Cancer. / Diaz, A.; Baade, P.; Valery, P. C.; Whop, L. J.; Moore, S. P.; Cunningham, J.; Garvey, G.; Brotheton, J.; O'Connell, D. L.; Canfell, K.; Sarfati, D.; Roder, D.; Buckley, E.; Condon, J. R.

    In: Asia-Pacific Journal of Clinical Oncology, Vol. 13, No. S4, 92, 01.11.2017, p. 92-93.

    Research output: Contribution to journalMeeting AbstractResearch

    TY - JOUR

    T1 - Higher Comorbidity Burden does not Explain Lower Survival for Indigenous Australian Women with Cervical Cancer

    AU - Diaz, A.

    AU - Baade, P.

    AU - Valery, P. C.

    AU - Whop, L. J.

    AU - Moore, S. P.

    AU - Cunningham, J.

    AU - Garvey, G.

    AU - Brotheton, J.

    AU - O'Connell, D. L.

    AU - Canfell, K.

    AU - Sarfati, D.

    AU - Roder, D.

    AU - Buckley, E.

    AU - Condon, J. R.

    PY - 2017/11/1

    Y1 - 2017/11/1

    N2 - Background: We aimed to investigate the effect of comorbidity on cervical cancer survival for Australian women, and whether it contributed to the excess mortality of Indigenous Australian women compared to non‐Indigenous women. Method: Cervical cancer cases diagnosed 2003–2012 in six Australian states/territories (covering 96% of the Australian female population) were linked to hospital inpatient records for the identification of comorbidity data. The weighted Charlson comorbidity index was calculated and categorised as a score 0 (no comorbidity), 1 or 2+. Kaplan Meier 5‐year cause‐specific survival probabilities were calculated by Indigenous status and comorbidity level. Flexible parametric survival models were used to model excess mortality by comorbidity score, for Indigenous and non‐Indigenous women. The effect of comorbidity on cancer stage at diagnosis was also investigated for a sub‐group of women from NSW, for whom staging data was available. Results: 4,467 Australian women (4.4% Indigenous) with cervical cancer were included. Indigenous women were younger and had more comorbidity at diagnosis (score ≥1 24% vs. 10%, respectively). Indigenous women had lower survival than non‐Indigenous women (60% vs. 77%). After adjustment for study factors, increased comorbidity was clearly associated with increased mortality for non‐Indigenous women, but not for Indigenous women. Stratified analysis showed that the survival disparity between Indigenous women and non‐Indigenous women was contained to those without comorbidity (HR 2.5, 95%CI 1.9‐3.4). Indigenous and non‐Indigenous women with comorbidity had similar survival. Conclusion: The difference in survival for Indigenous and non‐Indigenous women without comorbidity warrants further investigation and may reflect differences in how health services engage these women.

    AB - Background: We aimed to investigate the effect of comorbidity on cervical cancer survival for Australian women, and whether it contributed to the excess mortality of Indigenous Australian women compared to non‐Indigenous women. Method: Cervical cancer cases diagnosed 2003–2012 in six Australian states/territories (covering 96% of the Australian female population) were linked to hospital inpatient records for the identification of comorbidity data. The weighted Charlson comorbidity index was calculated and categorised as a score 0 (no comorbidity), 1 or 2+. Kaplan Meier 5‐year cause‐specific survival probabilities were calculated by Indigenous status and comorbidity level. Flexible parametric survival models were used to model excess mortality by comorbidity score, for Indigenous and non‐Indigenous women. The effect of comorbidity on cancer stage at diagnosis was also investigated for a sub‐group of women from NSW, for whom staging data was available. Results: 4,467 Australian women (4.4% Indigenous) with cervical cancer were included. Indigenous women were younger and had more comorbidity at diagnosis (score ≥1 24% vs. 10%, respectively). Indigenous women had lower survival than non‐Indigenous women (60% vs. 77%). After adjustment for study factors, increased comorbidity was clearly associated with increased mortality for non‐Indigenous women, but not for Indigenous women. Stratified analysis showed that the survival disparity between Indigenous women and non‐Indigenous women was contained to those without comorbidity (HR 2.5, 95%CI 1.9‐3.4). Indigenous and non‐Indigenous women with comorbidity had similar survival. Conclusion: The difference in survival for Indigenous and non‐Indigenous women without comorbidity warrants further investigation and may reflect differences in how health services engage these women.

    KW - Oncology

    U2 - 10.1111/ajco.12798

    DO - 10.1111/ajco.12798

    M3 - Meeting Abstract

    VL - 13

    SP - 92

    EP - 93

    JO - Asia-Pacific Journal of Clinical Oncology

    JF - Asia-Pacific Journal of Clinical Oncology

    SN - 1743-7555

    IS - S4

    M1 - 92

    ER -