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Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis

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Abstract

Objective

To examine associations between area and individual socio-economic characteristics and premature cancer mortality using multilevel analysis.

Methods

We modeled cancer mortality among 25–64-year-old men and women (n = 16,340) between 1998 and 2000 in Australia. Socio-economic characteristics of Statistical Local Areas (n = 1,317) were measured using an Index of Relative Socio-economic Disadvantage (quintiles), and individual socio-economic position was measured by occupation (professionals, white and blue collar).

Results

After adjustment for within-area variation in age and occupation, the probability of premature cancer mortality was highest in the most disadvantaged areas for all-cancer mortality for men (RR 1.48 95% CI 1.35–1.63) and women (RR 1.30 95% CI 1.18–1.43) and for lung cancer mortality for men (1.91 95% CI 1.63–2.25) and women (1.51 95% CI 1.04–2.18).

Men in blue collar occupations had a higher rate of cancer mortality (RR 1.57 95% CI 1.50–1.65) and lung cancer mortality (RR 2.31 95 % CI 2.09–2.56), whereas men in white collar occupations had a lower all-cancer mortality rate (RR 0.78 95% CI 0.72–0.85). Compared with professionals, women in white collar occupations had an all-cancer mortality rate that was lower (RR 0.85 95% CI 0.80–0.90). When deaths from breast cancer were excluded, women in blue collar occupations had a significantly higher all-cancer mortality rate than professionals (RR 1.12 95% CI 1.02–1.22).

Conclusions

Area disadvantage and individual socio-economic position were independently associated with premature cancer mortality, suggesting that interventions to reduce inequalities should focus on places and people.

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Acknowledgements

R. Bentley is supported by a National Health and Medical Research Council Capacity Building Grant in Population. Health Research (Australian Health Inequalities: A program addressing social and economic determinants of health). S. V. Subramanian is supported by the National Institutes of Health Career Development Award (NHLBI 1 K25 HL081275). Gavin Turrell is supported by a National Health and Medical Research Council Senior Research Fellowship (No. 390109).

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Authors and Affiliations

  1. Key Center for Women’s Health in Society, School of Population Health, University of Melbourne, Melbourne, Australia

    Rebecca Bentley & Anne Marie Kavanagh

  2. Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

    S. V. Subramanian

  3. School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia

    Gavin Turrell

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  1. Rebecca Bentley
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  2. Anne Marie Kavanagh
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  3. S. V. Subramanian
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  4. Gavin Turrell
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Correspondence to Rebecca Bentley.

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Bentley, R., Kavanagh, A.M., Subramanian, S. et al. Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis. Cancer Causes Control 19, 183–193 (2008). https://doi.org/10.1007/s10552-007-9084-7

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  • DOI: https://doi.org/10.1007/s10552-007-9084-7

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