Geographic remoteness and risk of advanced colorectal cancer at diagnosis in Queensland: a multilevel study

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Abstract
We examine the relationships between geographic remoteness, area disadvantage and risk of advanced colorectal cancer. Multilevel models were used to assess the area- and individual-level contributions to the risk of advanced disease among people aged 20–79 years diagnosed with colorectal cancer in Queensland, Australia between 1997 and 2007 (n=18 561). Multilevel analysis showed that colorectal cancer patients living in inner regional (OR=1.09, 1.01–1.19) and outer regional (OR=1.11, 1.01–1.22) areas were significantly more likely to be diagnosed with advanced cancer than those in major cities (P=0.045) after adjusting for individual-level variables. The best-fitting final model did not include area disadvantage. Stratified analysis suggested this remoteness effect was limited to people diagnosed with colon cancer (P=0.048) and not significant for rectal cancer patients (P=0.873). Given the relationship between stage and survival outcomes, it is imperative that the reasons for these rurality inequities in advanced disease be identified and addressed.