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Open Access Research article

Identification of area-level influences on regions of high cancer incidence in Queensland, Australia: a classification tree approach

Susanna M Cramb12*, Kerrie L Mengersen2 and Peter D Baade13

Author Affiliations

1 Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Gregory Tce, Fortitude Valley, Australia

2 Centre for Data Analysis, Modelling and Computation, Queensland University of Technology, George St, Brisbane, Australia

3 School of Public Health, Queensland University of Technology, Herston Rd, Kelvin Grove, Australia

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BMC Cancer 2011, 11:311  doi:10.1186/1471-2407-11-311

Published: 24 July 2011



Strategies for cancer reduction and management are targeted at both individual and area levels. Area-level strategies require careful understanding of geographic differences in cancer incidence, in particular the association with factors such as socioeconomic status, ethnicity and accessibility. This study aimed to identify the complex interplay of area-level factors associated with high area-specific incidence of Australian priority cancers using a classification and regression tree (CART) approach.


Area-specific smoothed standardised incidence ratios were estimated for priority-area cancers across 478 statistical local areas in Queensland, Australia (1998-2007, n = 186,075). For those cancers with significant spatial variation, CART models were used to identify whether area-level accessibility, socioeconomic status and ethnicity were associated with high area-specific incidence.


The accessibility of a person's residence had the most consistent association with the risk of cancer diagnosis across the specific cancers. Many cancers were likely to have high incidence in more urban areas, although male lung cancer and cervical cancer tended to have high incidence in more remote areas. The impact of socioeconomic status and ethnicity on these associations differed by type of cancer.


These results highlight the complex interactions between accessibility, socioeconomic status and ethnicity in determining cancer incidence risk.

cancer incidence; socioeconomic factors; indigenous population; rural health; classification and regression tree