Understanding the interplay of geography and demographic characteristics in the diagnosis of six-common cancers: The NASCAR-CENSUS project
When people develop cancer those that live in rural areas seems to suffer from more ill-health and have less chance of surviving than those that live in cities. This is the case in Scotland and has also been found in studies throughout the world. It is, however, not known why rural people with cancer do worse but there are several possibilities. If could be that they wait longer before contacting their GP. It could also be that, once they have contacted their GP the health service takes longer to diagnose them, and then they receive different treatment and follow-up than they would if they lived in the city.
To begin to explore why people in rural Scotland do worse with cancer we conducted the Northeast and Aberdeen Scottish Cancer and Residence Database (NASCAR) study. In the study detailed information was collected from over 12,000 people diagnosed with cancer in Northeast Scotland (including Orkney and Shetland) between 2007 and 2014. The results were surprising. We observed that people who lived on Orkney and Shetland or more than one hour’s drive from Aberdeen were actually more likely to be diagnosed and treated quickly for their cancer than those living in the city. Despite this, they were still more likely to die within a year.
We are now trying to explain these findings. By linking the existing information we have to data from the national census we will be able to begin to try and explain what we have found. In particular we are interested to learn if peoples’ access to transports, home circumstances and the type of work they do could be important. By linking our information to details from the census we will be able to answer these types of questions from our analyses.
The NASCAR project strongly suggests that cancer outcomes in the Northeast of Scotland will not be improved by exclusively focusing on initiatives to facilitate earlier cancer diagnosis in rural areas. NASCAR Census, however, will afford us greater insights to explain the paradoxical results we obtained in the original study, particularly how detailed demographics and geography interact in the pathways to diagnosis and treatment for cancer patients in Northeast Scotland.
. The NASCAR Database. This was formed in 2014 by linking data from the NHS Grampian Cancer Care Pathway database with routine national data. Linkage was performed by analysts at eDRIS. ISD Scotland. NASCAR is currently housed in the NHS Grampian/University of Aberdeen Data Safe Have (DaSH). Dr Peter Murchie, the lead researcher of this project is the data custodian of NASCAR.
. Data from the Scottish Census 2001 and 2011. We wish to link the following variables from census data to NASCAR. Accommodation type; adult life-stage; migrant status (age of arrival in UK and country of birth); car and van availability; distance to place of work or study; household composition; employment status and economic activity; English language skills; ethnicity; family type; self-reported health conditions; marital status; religion; method of travel and distance to work or study. Census data are currently held by the Scottish Government.
Dr Peter Murchie (lead researcher) University of Aberdeen / NHS Grampian
Dr Shona Fielding University of Aberdeen
Dr Melanie Turner University of Aberdeen
Ms Romi Carriere University of Aberdeen