1 Mahumud RA, et al. BMJ Open 2019;9:e031874. doi:10.1136/bmjopen-2019-031874 Open access Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 – 2014: an incidence-based approach in terms of trends, determinants and inequality Rashidul Alam Mahumud , 1,2,3,4 Khorshed Alam, 1,2 Jeff Dunn, 1,5,6 Jeff Gow 1,2,7 To cite: Mahumud RA, Alam K, Dunn J, et al. Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 – 2014: an incidence-based approach in terms of trends, determinants and inequality. BMJ Open 2019;9:e031874. doi:10.1136/ bmjopen-2019-031874 ► Prepublication history and additional material for this paper are available online. To view these fles, please visit the journal online (http://dx.doi. org/10.1136/bmjopen-2019- 031874). Received 28 May 2019 Revised 25 October 2019 Accepted 01 November 2019 For numbered affliations see end of article. Correspondence to Mr Rashidul Alam Mahumud; Rashed.Mahumud@usq.edu.au Original research © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Objective Cancer is a leading killer worldwide, including Australia. Cancer diagnosis leads to a substantial burden on the individual, their family and society. The main aim of this study is to understand the trends, determinants and inequalities associated with cancer incidence, hospitalisation, mortality and its burden over the period 1982 to 2014 in Australia. Settings The study was conducted in Australia. Study design An incidence-based study design was used. Methods Data came from the publicly accessible Australian Institute of Health and Welfare database. This contained 2 784 148 registered cancer cases over the study period for all types of cancer. Erreygers’ concentration index was used to examine the magnitude of socioeconomic inequality with regards to cancer outcomes. Furthermore, a generalised linear model was constructed to identify the infuential factors on the overall burden of cancer. Results The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation (AAPC=1.27%), cancer-related mortality (AAPC=0.76%) and burden of cancer (AAPC=0.84%) all increased signifcantly over the period. The same-day (AAPC=1.35%) and overnight (AAPC=1.19%) hospitalisation rates also showed an increasing trend. Further, the ratio (least-most advantaged economic resources ratio, LMR of mortality (M) and LMR of incidence (I)) was especially high for cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/ I=1.325), non-Hodgkin's lymphoma (M/I=1.325) and breast (M/I=1.318), suggesting that survival inequality was most pronounced for these cancers. Socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality and death. Conclusions Signifcant differences in the burden of cancer persist across socioeconomic strata in Australia. Policymakers should therefore introduce appropriate cancer policies to provide universal cancer care, which could reduce this burden by ensuring curable and preventive cancer care services are made available to all people. BACKGROUND Non-communicable diseases (NCDs) are accountable for the majority of global deaths. 1 Cancer is expected to rank as the most signif- icant global public health problem and a leading cause of death and illness in the world in the 21 st century 2–6 including Australia. 7 In 2019, it is estimated that almost 145 000 new cases of cancer will be diagnosed in Australia, and 35% of these individuals will eventually die from the disease. 7 Cancer accounts for the highest burden of disease of any illness, at approximately 18% (19% for males; 17% for females), followed by cardiovascular disease (14%), musculoskeletal (13%) and mental health (12%). 8 Approximately 40% of cancer patients are of working age in Australia. 7 Among those in employment, 46% are unable to return to work after an episode, 9 and 67% return to employment or change their job after being diagnosed. 10 The majority of Strengths and limitations of this study ► This study examined the trends, determinants and inequality in terms of incidence, mortality, hospital- isation and associated burden of cancer (eg, years life lost, years lost due to disability and disability- adjusted life years) in the Australian context over a 33 year period. ► This study was not captured in details inequalities regarding the cancer survivorship in terms of stage, treatment procedures and utilisation of healthcare. ► Although we have limited understanding of what is driving these changes in cancer outcomes as report- ed here they may refect random variation or chang- es in unknown risk factors, and therefore highlight the need for more research into the aetiology of cancer. 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