Indigenous Inequities in the Presentation and Management of Stomach Cancer in New Zealand: a Country with Universal Health Care Coverage

Background: Māori in New Zealand have markedly higher incidence and poorer survival from stomach cancer than non-Māori. We investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients.

Methods: A clinical notes review of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori, was conducted (final cohort n = 335). Patient characteristics, tumour characteristics, receipt and timing of treatment and cancer-specific survival were compared.

Results: Compared to non-Māori, Māori patients had a younger average age at diagnosis, higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43 % Māori, 26 % non-Māori, p = 0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66 %) of stage I-III patients had definitive surgery, with similar rates for Māori (71 %) and non-Māori (68 %). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38 % Māori, 79 % non-Māori, p < 0.01) and less likely to be treated in a main centre (44 % Māori, 87 % non-Māori, p < 0.01). After adjusting for age, sex, stage, tumour site and comorbidity, Māori had nonsignificant 27 % poorer survival (hazard ratio 1.27, 95 % CI 0.96-1.68).

Conclusions: There was evidence of differential presentation and access to specialised surgical services, as well as differential survival, for Māori stomach cancer patients compared to non-Māori. These findings support the development of the national stomach cancer treatment standards and highlight the need for an equity focus within these guidelines.