Associations between socio-demographic disadvantage and cancer incidence, mortality and survival are widely acknowledged, with socio-demographic disadvantage normally being equated with poorer cancer outcomes. Poorer outcomes can be explained by differences in risk factor profiles (e.g., smoking, alcohol consumption, diet, and exercise), social factors (e.g., education, income, and social support) and system level factors (access to and quality of diagnostic, screening and treatment services). In Australia, priority population groups often include people of lower socio-economic status, those living in rural and remote areas, Aboriginal and Torres Strait Islander people and overseas born people. Population-based cancer registry data are commonly used to examine and quantify cancer outcome inequalities. Even though it is generally acknowledged that such groups may require special attention in service delivery to address health disadvantage, accurately identifying these groups and consequently measuring health disadvantage so as to better target and evaluate service impacts can be challenging.
This presentation provides an overview of methodologies and main findings of studies examining socio-demographic disadvantage and cancer outcomes using population-based data from the NSW Central Cancer Registry. Several challenges were encountered in measuring socio-demographic disadvantage in cancer incidence, mortality, survival, stage at diagnosis and patterns of care. They resulted from under-recording of Aboriginal and Torres Strait Islander status in health registries, sub-optimal access to denominator population data for certain population sub-groups, difficulties retrieving data on inequalities in patterns of care, complexities encountered when measuring ethnic inequalities in the diverse cultural environment of Australia, and limitations of using area-level measurements of socio-economic status which may mask differences. Potential consequences of not meeting these measurement challenges are discussed as well as approaches to resolving them, such that services can be better targeted and evaluated.