Demographic, health, and prognostic characteristics of Australians with liver cancer: a cohort study of linked data in New South Wales for informing cancer control.

ABSTRACT

BACKGROUND: Australian age-standardized incidence and death rates for liver cancer are lower than world averages, but increasing as in other economically advanced western countries. World Health Organization emphasizes the need to address sociodemographic disparities in cancer risk. A more detailed sociodemographic risk profiling was undertaken for liver cancer in New South Wales (NSW) by diagnostic stage, than possible with NSW Cancer Registry (NSWCR) alone, by incorporating linked data from the Australian Bureau of Statistics (ABS). The purpose was to inform targeting and monitoring of cancer services. METHODS: The ABS manages the Multi-Agency Data Integration Project (MADIP) which includes a wide range of health, educational, welfare, census, and employment data. These data were linked at person level to NSWCR liver cancer registrations for the period post 2016 census to December 2018. De-identified data were analyzed. Sex-specific age-adjusted odds ratios (95%CIs) of liver cancer were derived using logistic regression by age, country of birth, residential remoteness, proficiency in spoken English, household income, employment status, occupation type, educational attainment, sole person household, joblessness, socioeconomic status, disability status, multimorbidity, and other health-related factors, including GP consultations. These data complement the less detailed sociodemographic data available from the NSWCR, with alignment of numerators and population denominators for accurate risk assessment. RESULTS: Results indicate liver cancer disproportionately affects population members already experiencing excess social and health disadvantage. Examples where 95% confidence intervals of odds ratios of liver cancer were elevated included having poor English-speaking proficiency, limited education, housing authority tenancy, living in sole-person households, having disabilities, multiple medicated conditions, and being carers of people with a disability. Also, odds of liver cancer were higher in more remote regions outside major cities, and in males, with higher odds of more advanced cancer stages (degrees of spread) at diagnosis in more remote regions. CONCLUSIONS: Linked data enabled more detailed risk profiling than previously possible. This will support the targeting of cancer services and benchmarking.