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dc.contributor.authorTin Tin, Sandaren_NZ
dc.contributor.authorElwood, J. Marken_NZ
dc.contributor.authorBrown, Charisen_NZ
dc.contributor.authorSarfati, Dianaen_NZ
dc.contributor.authorCampbell, Ianen_NZ
dc.contributor.authorScott, Ninaen_NZ
dc.contributor.authorRamsaroop, Reenaen_NZ
dc.contributor.authorSeneviratne, Sanjeewaen_NZ
dc.contributor.authorHarvey, Vernonen_NZ
dc.contributor.authorLawrenson, Rossen_NZ
dc.date.accessioned2018-07-30T02:45:50Z
dc.date.available2018-01-08en_NZ
dc.date.available2018-07-30T02:45:50Z
dc.date.issued2018en_NZ
dc.identifier.citationTin Tin, S., Elwood, J. M., Brown, C., Sarfati, D., Campbell, I., Scott, N., … Lawrenson, R. (2018). Ethnic disparities in breast cancer survival in New Zealand: which factors contribute? BMC Cancer, 18(1), 1–10. https://doi.org/10.1186/s12885-017-3797-0en
dc.identifier.urihttps://hdl.handle.net/10289/11989
dc.description.abstractBackground: New Zealand has major ethnic disparities in breast cancer survival with Maori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential. Methods: This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Maori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Maori and Pacific patients were assessed. Results: Of the 13,657 patients who were included in this analysis, 1281 (9.4%) were Maori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51-2.04 for Maori and 1.97; 95% CI: 1.67-2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy. Conclusions: Late diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Maori and Pacific women.en_NZ
dc.format.mimetypeapplication/pdf
dc.language.isoen
dc.publisherBioMed central
dc.rights© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.subjectBreast cancer
dc.subjectSurvival
dc.subjectEthnic groups
dc.subjectMediation
dc.subjectNew Zealand
dc.titleEthnic disparities in breast cancer survival in New Zealand: which factors contribute?en_NZ
dc.typeJournal Article
dc.identifier.doi10.1186/s12885-017-3797-0en_NZ
dc.relation.isPartOfBMC Canceren_NZ
pubs.begin-page1
pubs.elements-id217344
pubs.end-page10
pubs.issue1en_NZ
pubs.publication-statusPublisheden_NZ
pubs.volume18en_NZ
dc.identifier.eissn1471-2407en_NZ


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