Invasive Melanoma Mortality to Incidence Ratios by Local Health District in New South Wales 2007-2011 Dr Jeff Keir MBBS MFamMed FRACGP FSCCA University of Queensland, School of Medicine SunDoctors, Ballina Far West Western Murrumbidgee Albury Nepean Blue Mountains Hunter New England Southern Northern Mid North Coast Central Coast North Sydney Sydney South East Sydney South West Sydney Illawarra Shoalhaven A/Prof Cliff Rosendahl PhD MBBS FSCCA University of Queensland, School of Medicine
Overview Effectiveness of melanoma diagnosis and treatment is reflected in case mortality rates The mortality to incidence ratio (MIR) is a valid proxy for comparing case mortality rates on a population basis* A high MIR may indicate the need for improvement in care A low MIR may indicate improved care. * European Journal of Public Health, Vol. 21, No. 5, 573 577
Objective To calculate and rank MIRs for invasive melanoma for each NSW Local Health District (LHD) Examine the correlation of MIR with mortality and incidence rates
Method Age-standardised MIRs were calculated from NSW Cancer Registry Data for 2007-2011 http://www.statistics.cancerinstitute.org.au/ These were standardised as a ratio against the NSW average. LHDs were ranked by MIR Correlations were calculated between MIR and incidence and MIR and mortality.
Results Lowest MIR was for the Northern LHD at 0.6 x the state average Highest MIR was the Southern LHD at 1.37 x the state average MIR: strongly negatively correlated with increasing incidence weakly negatively correlated with increasing mortality rate
Northern 1707 Mid North Coast 966 Hunter New England 3094 Central Coast 1176 Northern Sydney 2409 Illawarra Shoalhaven 1156 Western 754 NSW 18825 South East Sydney 2148 Murrumbidgee 641 Southern 533 Far West 84 Nepean Blue Mountains 719 Albury 103 Western Sydney 1223 South West Sydney 1315 Sydney 797 Invasive Melanoma Incidence by NSW LHD 2007-2011 no. cases State average 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Standardised Incidence (per 100,000/year)
Invasive Melanoma Incidence by NSW LHD 2007-2011 Incidence (per 100,000 per year) 90-99 80-89 70-79 60-69 50-59 40-49 30-39 20-29
Southern 97 Mid North Coast 118 Western 117 Northern 321 Hunter New England 373 Central Coast 156 Far West 13 Northern Sydney 321 Illawarra Shoalhaven 153 NSW 2456 Albury 16 South East Sydney 277 Nepean Blue Mountains 94 South West Sydney 207 Murrumbidgee 77 Western Sydney 173 Sydney 123 Invasive Melanoma Mortality Rate by NSW LHD 2007-2011 no. cases 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 Mortality (per 100,000/year) State average
Invasive Melanoma Mortality by NSW LHD 2007-2011 8.0-8.9 7.0-7.9 6.0-6.9 5.0-5.9 4.0-4.9 Mortality (per 100,000 per year)
Southern 0.174 South West Sydney 0.162 Far West 0.159 Sydney 0.157 Albury 0.15 Western 0.146 Western Sydney 0.145 Nepean Blue Mountains 0.134 NSW 0.127 Illawarra Shoalhaven 0.125 Northern Sydney 0.125 South East Sydney 0.122 Central Coast 0.116 Hunter New England 0.114 Mid North Coast 0.113 Murrumbidgee 0.111 Northern 0.074 Ranked Ratio of LHD MIR to State Average MIR 2007-2011 MIR State average 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 Ratio of LHD MIR to State Average MIR
Ratio of LHD MIR to NSW State Average MIR 2007-2011 Ratio of LHA MIR to State Average MIR 1.3-1.39 1.2-1.29 1.1-1.19 1.0-1.09 0.9-0.99 0.8-0.89 0.7-0.79 0.6-0.69 0.5-0.59
1.40 1.30 1.20 Sydney NSW LHD MIR Ratio vs Standardised Incidence 2007-2011 Southern Ratio of LHD MIR to NSW State Average MIR 1.10 1.00 0.90 0.80 0.70 Murrumbidgee r = -0.83 0.60 Northern 0.50 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Standardised Incidence (per 100,000/yr)
NSW LHD MIR Ratio vs Standardised Mortality 2007-2011 1.40 Southern 1.30 1.20 Sydney Ratio of LHD MIR to NSW State Average MIR 1.10 1.00 0.90 0.80 Murrumbidgee r = -0.19 0.70 0.60 0.50 4 4.5 5 5.5 6 6.5 7 7.5 8 Standardised Mortality (per 100,000/yr) Northern
Discussion Reduced MIR may be correlated with increased incidence for a number of reasons Increased awareness of risk by population Increased awareness by medical practitioners Increased presentations for skin & lesion checks Increased clinical suspicion & diagnostic expertise Increased proportion of indolent melanoma subtypes Over-reporting Increased treatment adequacy: early &/or advanced disease
if the lowest MIR LHD outcomes were replicated across NSW Potential annual mortality reduction ~185
Potential Mortality Reduction : Cases by LHD 2007 2011* Hunter New England 121 Northern Sydney 125 South Eastern Sydney 102 South Western Sydney 100 Western Sydney 73 Central Coast 60 Illawarra Shoalhaven 59 Northern 0 Sydney Mid North Coast Western Southern 54 56 58 39 * if MIR reduced to same as Northern LHD Nepean Blue Mountains 35 Murrumbidgee 25 Albury 8 Far West 6 0 50 100 150 200 250 300 350 400 Invasive Melanoma Mortality : cases
Conclusion MIRs across NSW LHDs vary widely but are strongly inversely associated with incidence The factors affecting this variation are unknown and bear further study A significant reduction in melanoma mortality could eventuate if the outcomes of the best performing LHD are replicated across the state