Keratinocyte carcinomas, area-level socioeconomic status and geographic remoteness in Tasmania: cross-sectional associations and temporal trends.

ABSTRACT

OBJECTIVE: This article aims to examine cross-sectional associations and assess temporal trends in keratinocyte carcinoma (KC) incidence by area-level socioeconomic status (SES) and geographic remoteness in Tasmania, Australia. METHODS: KCs - basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) - registered by the Tasmanian Cancer Registry were assigned to area-level SES and remoteness area. Incidence rate ratios (2014-2018) were estimated using Poisson regression. Average annual percentage changes (2001-2018) were estimated using the Joinpoint Regression Program. RESULTS: BCC incidence increased with increasing area-level advantage (p-value for trend <0.001), but no trend was found for SCC. SCC incidence was higher in rural than urban areas (p-value <0.001), and BCC incidence was slightly higher in rural than urban areas for females (p-value = 0.009), but not for males (p-value = 0.373). BCC and SCC incidence increased between 2001 and the mid-2010s, when it peaked across most areas. CONCLUSIONS: Associations were found between BCC and higher area-level SES, and between SCC and geographic remoteness. The findings suggest differences in sun exposure behaviours, skin cancer awareness and access to services, or ascertainment bias. IMPLICATIONS FOR PUBLIC HEALTH Efforts to control and deliver KC services in Tasmania should consider targeting populations with specific area-level characteristics.