Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study

Abstract

A woman's risk of being diagnosed as having advanced breast cancer depends on where she lives, separate from the individual characteristics of the woman herself. Both the rurality and socio-economic characteristics of the geographical area in which women lived were important. The socio-economic factors contributing to advanced breast cancer, existing in both urban and rural environments, need to be investigated.

Rural disadvantage in breast cancer health-care service use and outcomes: quantifying the effects of individual risk factors and health service risk factors

“…The results are unlikely to be due to screening service access alone, because similar observations have been found in other studies that adjusted for mammography and service access [77,78]. The study by Baade et al [64] was the first Australian study to provide evidence that rural women were likely to be at a more advanced stage at breast cancer diagnosis. However, the cancer registry data provided a limited number of individual factors for analysis.…”

“…Furthermore, SES may influence how breast cancer patients access and use health services. Compared to urban women, rural women with lower SES are less likely to access breast cancer screening services [64]. As previously discussed, this is likely to lead to a more advanced stage at diagnosis, and poorer survival.…”

“…There is evidence that breast cancer patients residing in rural areas are more likely to have a later stage at breast cancer diagnosis. This was observed in an Australian study in a population sample of women aged 30-80 years [64], in which rural residency was defined by the standard Australian measure, Accessibility/Remoteness Index of Australia Plus (ARIA+) [43]. Over 50% of women living in inner regional, outer regional, remote and very remote areas were found to have advanced breast cancer at diagnosis, compared to 46% of urban women.…”

“…Some studies defined urban and rural areas based on population size or density [170,174,176]. Other studies used a standard system of rural and urban classification, such as the Rural Urban Commuting Area Codes [162,168,171], Census classifications [159,163,164], and the Accessibility/Remoteness Index of Australia [172,173]. One study defined urban areas as areas without food production [178].…”

“…There were 13 studies from the United States [77,159,[161][162][163][164][165][166][167][168][169][170][171], which is over half of all included studies. There were two studies from Australia [172,173], two from New Zealand [174,175], and one study each from Canada [176], Denmark [78], Egypt [136], Italy [177], Norway [178], Poland [179], and South Africa [180]. [180], while all other studies utilized existing data sources such as cancer registry and census data.…”