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dc.contributor.authorDiaz, Abbey
dc.contributor.authorBaade, Peter D
dc.contributor.authorValery, Patricia C
dc.contributor.authorWhop, Lisa J
dc.contributor.authorMoore, Suzanne P
dc.contributor.authorCunningham, Joan
dc.contributor.authorGarvey, Gail
dc.contributor.authorBrotherton, Julia ML
dc.contributor.authorO'Connell, Dianne L
dc.contributor.authorCanfell, Karen
dc.contributor.authorSarfati, Diana
dc.contributor.authorRoder, David
dc.contributor.authorBuckley, Elizabeth
dc.contributor.authorCondon, John R
dc.date.accessioned2019-07-05T03:53:53Z
dc.date.available2019-07-05T03:53:53Z
dc.date.issued2018
dc.identifier.issn1932-6203
dc.identifier.doi10.1371/journal.pone.0196764
dc.identifier.urihttp://hdl.handle.net/10072/386181
dc.description.abstractBackground: Little is known about the impact of comorbidity on cervical cancer survival in Australian women, including whether Indigenous women’s higher prevalence of comorbidity contributes to their lower survival compared to non-Indigenous women. Methods: Data for cervical cancers diagnosed in 2003–2012 were extracted from six Australian state-based cancer registries and linked to hospital inpatient records to identify comorbidity diagnoses. Five-year cause-specific and all-cause survival probabilities were estimated using the Kaplan-Meier method. Flexible parametric models were used to estimate excess cause-specific mortality by Charlson comorbidity index score (0,1,2+), for Indigenous women compared to non-Indigenous women. Results: Of 4,467 women, Indigenous women (4.4%) compared to non-Indigenous women had more comorbidity at diagnosis (score ≥1: 24.2% vs. 10.0%) and lower five-year cause-specific survival (60.2% vs. 76.6%). Comorbidity was associated with increased cervical cancer mortality for non-Indigenous women, but there was no evidence of such a relationship for Indigenous women. There was an 18% reduction in the Indigenous: non-Indigenous hazard ratio (excess mortality) when comorbidity was included in the model, yet this reduction was not statistically significant. The excess mortality for Indigenous women was only evident among those without comorbidity (Indigenous: non-Indigenous HR 2.5, 95%CI 1.9–3.4), indicating that factors other than those measured in this study are contributing to the differential. In a subgroup of New South Wales women, comorbidity was associated with advanced-stage cancer, which in turn was associated with elevated cervical cancer mortality. Conclusions: Survival was lowest for women with comorbidity. However, there wasn’t a clear comorbidity-survival gradient for Indigenous women. Further investigation of potential drivers of the cervical cancer survival differentials is warranted. Impact: The results highlight the need for cancer care guidelines and multidisciplinary care that can meet the needs of complex patients. Also, primary and acute care services may need to pay more attention to Indigenous Australian women who may not obviously need it (i.e. those without comorbidity).
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherPublic Library of Science
dc.relation.ispartofpagefrom1
dc.relation.ispartofpageto18
dc.relation.ispartofissue5
dc.relation.ispartofjournalPLoS One
dc.relation.ispartofvolume13
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode11
dc.titleComorbidity and cervical cancer survival of Indigenous and non-Indigenous Australian women: A semi-national registry-based cohort study (2003-2012)
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
dcterms.licensehttp://creativecommons.org/licenses/by/4.0/
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2018 Diaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
gro.hasfulltextFull Text
gro.griffith.authorBaade, Peter D.


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