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Survival of Indigenous and non-Indigenous Queenslanders after a diagnosis of lung cancer: a matched cohort study

Med J Aust 2008; 188 (10): 562-566.

Summary

Objective: To compare survival of Indigenous and non-Indigenous lung cancer patients and to investigate any corresponding differences in stage, treatment and comorbidities.

Design and setting: Cohort study of 158 Indigenous and 152 non-Indigenous patients (frequency-matched on age, sex and rurality) diagnosed with lung cancer between 1996 and 2002 and treated in Queensland public hospitals.

Main outcome measures: Survival after diagnosis of lung cancer; effects of stage at diagnosis, treatment, comorbidities and histological subtype on lung cancer-specific survival.

Results: Survival of Indigenous lung cancer patients was significantly lower than that of non-Indigenous patients (median survival, 4.3 v 10.3 months; hazard ratio, 1.48; 95% CI, 1.14–1.92). Of 158 Indigenous patients, 72 (46%) received active treatment with chemotherapy, radiotherapy or surgery compared with 109 (72%) of the 152 non-Indigenous patients, and this treatment disparity remained after adjusting for histological subtype, stage at diagnosis, and comorbidities (adjusted risk ratio, 0.65; 95% CI, 0.53–0.73). The treatment disparity explained most of the survival deficit: the hazard ratio reduced to 1.10 (95% CI, 0.83–1.44) after inclusion of treatment variables in the proportional hazards survival model. The remaining survival deficit was explained by the higher prevalence of comorbidities among Indigenous cancer patients, mainly diabetes.

Conclusion: Survival after a diagnosis of lung cancer is worse for Indigenous patients than for non-Indigenous patients, and differences in treatment between the two groups are mainly responsible.

  • Michael D Coory1
  • Adele C Green2
  • Janelle Stirling2
  • Patricia C Valery2

  • 1 School of Population Health, University of Queensland, Brisbane, QLD.
  • 2 Queensland Institute of Medical Research, Brisbane, QLD.

Correspondence: m.coory@uq.edu.au

Acknowledgements: 

We thank Mrs Valerie Logan for technical support, Ms Judy Symmons for data collection and the Queensland Aboriginal and Islander Health Forum for acting as a community resource to provide community consultation. This work has been produced as part of the activities of the Cooperative Research Centre for Aboriginal Health, a collaborative partnership partly funded by the CRC Programme of the Commonwealth Department of Education, Science and Technology. Perpetual – Derham Green Fund funded the study; Patricia Valery is supported by a National Health and Medical Research Council Public Health (Australia) Training Fellowship.

Competing interests:

None identified.

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