Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
| Autor: | Paula Manchon-Walsh, Luisa Aliste, Josep M. Borràs, Cristina Coll-Ortega, Joan Casacuberta, Cristina Casanovas-Guitart, Montse Clèries, Sergi Cruz, Àlex Guarga, Anna Mompart, Antoni Planella, Alfonso Pozuelo, Isabel Ticó, Emili Vela, Joan Prades |
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| Rok vydání: | 2022 |
| Předmět: |
Public health
Rectal Neoplasms health equity centralization quality of cancer care health care access geographical distance reference centre socioeconomic status Health Toxicology and Mutagenesis Public Health Environmental and Occupational Health Drets socials i econòmics Health Status Disparities Salut pública Colorectal cancer Health Services Accessibility Cohort Studies Pancreatic Neoplasms Social Class Socioeconomic Factors Spain Càncer colorectal Humans Social and economic rights Càncer de pàncrees Pancreas cancer |
| Zdroj: | Dipòsit Digital de la UB Universidad de Barcelona International Journal of Environmental Research and Public Health; Volume 19; Issue 14; Pages: 8814 |
| Popis: | The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011–12) and pancreatic cancer (2012–15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients’ homes and their reference centers, clinical patient and treatment data, income category, and data from the patients’ district hospitals. A composite ‘textbook outcome’ was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium–high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15–1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51–7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival. |
| Databáze: | OpenAIRE |
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