Published in:
Open Access 01-12-2011 | Research article
Identification of area-level influences on regions of high cancer incidence in Queensland, Australia: a classification tree approach
Published in: BMC Cancer | Issue 1/2011
Login to get accessAbstract
Background
Strategies for cancer reduction and management are targeted at both individual and area levels. Area-level strategies require careful understanding of geographic differences in cancer incidence, in particular the association with factors such as socioeconomic status, ethnicity and accessibility. This study aimed to identify the complex interplay of area-level factors associated with high area-specific incidence of Australian priority cancers using a classification and regression tree (CART) approach.
Methods
Area-specific smoothed standardised incidence ratios were estimated for priority-area cancers across 478 statistical local areas in Queensland, Australia (1998-2007, n = 186,075). For those cancers with significant spatial variation, CART models were used to identify whether area-level accessibility, socioeconomic status and ethnicity were associated with high area-specific incidence.
Results
The accessibility of a person's residence had the most consistent association with the risk of cancer diagnosis across the specific cancers. Many cancers were likely to have high incidence in more urban areas, although male lung cancer and cervical cancer tended to have high incidence in more remote areas. The impact of socioeconomic status and ethnicity on these associations differed by type of cancer.
Conclusions
These results highlight the complex interactions between accessibility, socioeconomic status and ethnicity in determining cancer incidence risk.