Alice R T Bergin, Luc Te Marvelde, Roger L Milne, Benjamin J Solomon, Kris Ivanova, Peter Savas, Stephen J Luen, Jay Hamann, Andrea Casey, Nicole Watt, Sue M Evans, Gail Garvey, Sherene Loi
This study identified that Aboriginal people were younger, more likely to be living outside of major cities and in areas of greatest inequity than non-Aboriginal people, which is an ongoing manifestation of colonisation. Aboriginal people diagnosed with lung cancer had an increased all-cause mortality compared with non-Aboriginal people.
OBJECTIVE: To identify factors contributing to the known increased age-standardised incidence and mortality rates for lung cancer for Aboriginal and Torres Strait Islander people in Victoria, Australia.
STUDY TYPE: Retrospective, population-based, case-control study using Victorian Cancer Registry (VCR) data and linked health administrative datasets.
SETTING AND PARTICIPANTS: Self-identified Aboriginal and Torres Strait Islander people (respectfully referred to hereon as Aboriginal) and non-Aboriginal people (aged > 18 years) diagnosed with lung cancer from 1 January 2008 to 31 December 2022.
MAIN OUTCOME MEASURES: Clinical, pathological, demographic, socio-economic factors and biomarkers (programmed cell death-ligand 1 [PD-L1], anaplastic lymphoma kinase [ALK] and c-ros oncogene [ROS1]) were assessed. Endpoints were all-cause and lung cancer-specific mortality. Survival analyses were conducted using Cox regression.
RESULTS: Aboriginal people (N = 512) were younger (p < 0.001), more likely to live outside a major city (p < 0.001) and in areas of greatest disadvantage (p < 0.001) than non-Aboriginal people (N = 43,468). More Aboriginal females had small cell lung cancer compared with non-Aboriginal females (17% vs. 10%), more Aboriginal males had adenocarcinomas (41% vs. 36%) and squamous cell carcinomas (26% vs. 20%), compared with non-Aboriginal males. There were no differences in the proportions of PD-L1-positive disease nor ALK or ROS1 gene rearrangements. A higher risk of all-cause mortality (hazard ratio, 1.12; 95% CI, 1.01-1.24; p = 0.03) for Aboriginal people after stratification for age, sex and lung cancer subtype was identified.
CONCLUSION: This study identified that Aboriginal people were younger, more likely to be living outside of major cities and in areas of greatest inequity than non-Aboriginal people, which is an ongoing manifestation of colonisation. Aboriginal people diagnosed with lung cancer had an increased all-cause mortality compared with non-Aboriginal people.