Scottish Longitudinal Study
Development & Support Unit

Current Projects

Project Title:

Cancer survival in Scotland: does geography matter?

Project Number:



Noor Saeed (University of St Andrews)
Jed Long (University of St Andrews)
Alan Marshall (University of St Andrews)
Zhiqiang Feng (University of Edinburgh)

Start Date:

24 March 2016



Scotland has the lowest life expectancy in Western Europe, the slowest rate of health improvement in Europe and wide health inequalities (Hanlon, Lawder et al. 2005). Previous research has demonstrated that Scottish cancer survival rates are similarly poor; for example, Gatta, Ciccolallo et al. (2006) found that cancer survival rates for Scottish women were the lowest in Europe and for men they were in the bottom four. In addition to deprivation, one of the many possible influences on health relates to access to services. This research will use individual level data provided by the Scottish Longitudinal Studies (SLS) to explore cancer survival in the Scottish context using survival analysis techniques. The analysis will examine whether cancer survival is predicted by levels of deprivation (individual and area), access and proximity to health services and the level of remoteness of the area of residence.

This research is different from Sharpe, McMahon et al. (2014) recent work which has focused on cancer incidence of lung and upper aero-digestive tract cancer risk using SLS data, while this research is focusing on cancer survival, especially geographical impact on survival which will focus on the four major cancer risks (in terms of highest mortality) in Scotland for total populations (for all male and female age 15+). The four major cancers in terms of highest mortality in Scotland for all persons are; Lung (26.5%), Colorectal (10.3%), Breast (6.8%) and Prostate (5.6%) which accounts for 49.2% of total cancer deaths in Scotland (NSS, 2014).

I will also request data for all cancers combined (I will not get information on cancer type) which will include the above four cancer types. I aim to analyse this data at a later stage as this will be useful if the numbers for the above requested cancers for SLS members are too small to analyse.

Whilst Sharpe, McMahon et al. (2014) have focused on the cancer incidence in their study using SLS, this study will look into the cancer survival by urban and rural areas, using survival analysis techniques and will be linked to geographical locations. Accessibility to health services (like hospitals, GPs and medical centers) for cancer treatment from residence locations will be calculated using GIS Network analysis techniques which will be used to conceptualise and quantify ‘accessibility’ to health services in the context of cancer treatment.


The relationship between area inequalities and accessibility to health services represent a challenging task and there exists a clear evidence of social inequity in spatial distribution of healthcare facilities including primary care services (Guagliardo, Ronzio et al. 2004). This research will explore how area inequalities and accessibility to health services impact on cancer survival with the specific aim to identify the areas that have poor geographical accessibility to heath care services. This research is looking for all male and female SLS members aged 15+ and enumerated at the 1991, 2001 or 2011 censuses to explore the following specific research questions:

  1. How and why does cancer survival vary across Scotland?
  2. Is spatial variation in cancer survival associated with area types (urban/rural, deprivation)?
  3. Is cancer survival linked to accessibility to health services? ( accessibility index will be created based on time and distance from people’s residence to healthcare centres)

The results of this research will be used to help Scottish Government and health departments (for example, NHS National Services Scotland, ISD, Public Health and Intelligence Team Scotland) within Scotland identify the accessibility barriers to health care. This research will demonstrate how geographical accessibility measures can be used to revise health care policies for good within Scotland.


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Campbell, N., et al. (2001). "Rural and urban differences in stage at diagnosis of colorectal and lung cancers." British journal of cancer 84(7): 910.

Campbell, N., et al. (2002). "Impact of deprivation and rural residence on treatment of colorectal and lung cancer." British journal of cancer 87(6): 585-590.

Crawford, S. M., et al. (2012). "Social and geographical factors affecting access to treatment of colorectal cancer: a cancer registry study." BMJ open 2(2).

Crawford, S. M., et al. (2009). "Social and geographical factors affecting access to treatment of lung cancer." British journal of cancer 101(6): 897-901.

Gatta, G., et al. (2006). "Survival from rare cancer in adults: a population-based study." The Lancet Oncology 7(2): 132-140.

Guagliardo, M. F., et al. (2004). "Physician accessibility: an urban case study of pediatric providers." Health Place 10(3): 273-283.

Hanlon, P., et al. (2005). "Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a ‘Scottish Effect’." Journal of Public Health 27(2): 199-204.

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Haynes, R., et al. (2008). "Cancer survival in New Zealand: ethnic, social and geographical inequalities." Soc Sci Med 67(6): 928-937.

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Jemal, A., et al. (2005). "Geographic patterns of prostate cancer mortality and variations in access to medical care in the United States." Cancer Epidemiology Biomarkers & Prevention 14(3): 590-595.

Jones, A., et al. (2008). "Travel time to hospital and treatment for breast, colon, rectum, lung, ovary and prostate cancer." European Journal of Cancer 44(7): 992-999.

Jones, A., et al. (2008). "Travel times to health care and survival from cancers in Northern England." European Journal of Cancer 44(2): 269-274.

Liff, J. M., et al. (1991). "Rural–urban differences in stage at diagnosis. Possible relationship to cancer screening." Cancer 67(5): 1454-1459.

McLeod, A. (1999). "Variation in the provision of chemotherapy for colorectal cancer." Journal of Epidemiology and Community Health 53(12): 775-781.

Sharpe, K. H., et al. (2014). "Association between Socioeconomic Factors and Cancer Risk: A Population Cohort Study in Scotland (1991-2006)." Plos One 9(2): 15.

Sharpe, K. H., et al. (2014). "Association between socioeconomic factors and cancer risk: a population cohort study in Scotland (1991-2006)."

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