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Servadio M, Rosa AC, Addis A, Kirchmayer U, Cozzi I, Michelozzi P, Cipelli R, Heiman F, Davoli M, Belleudi V. Investigating socioeconomic disparities in lung cancer diagnosis, treatment and mortality: an Italian cohort study. BMC Public Health 2024; 24:1543. [PMID: 38849792 DOI: 10.1186/s12889-024-19041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Lung cancer is one of the most lethal cancers worldwide and patient clinical outcomes seem influenced by their socioeconomic position (SEP). Since little has been investigated on this topic in the Italian context, our aim was to investigate the role of SEP in the care pathway of lung cancer patients in terms of diagnosis, treatment and mortality. METHODS This observational retrospective cohort study included patients discharged in the Lazio Region with a lung cancer diagnosis between 2014 and 2017. In the main analysis, educational level was used as SEP measure. Multivariate models, adjusted for demographic and clinical variables, were applied to evaluate the association between SEP and study outcomes, stratified for metastatic (M) and non-metastatic (NM) cancer. We defined a diagnosis as 'delayed' when patients received their initial cancer diagnosis after an emergency department admission. Access to advanced lung cancer treatments (high-cost, novel and innovative treatments) and mortality were investigated within the 24-month period post-diagnosis. Moreover, two additional indicators of SEP were examined in the sensitivity analysis: one focusing on area deprivation and the other on income-based exemption. RESULTS A total of 13,251 patients were identified (37.3% with metastasis). The majority were males (> 60%) and over half were older than 70 years. The distribution of SEP levels among patients was as follow: 31% low, 29% medium-low, 32% medium-high and 7% high. As SEP increased, the risks of receiving a delayed diagnosis ((high vs low: M: OR = 0.29 (0.23-0.38), NM: OR = 0.20 (0.16-0.25)) and of mortality ((high vs low M: OR = 0.77 (0.68-0.88) and NM: 0.61 (0.54-0.69)) decreased. Access to advanced lung cancer treatments increased in accordance with SEP only in the M cohort (high vs low: M: OR = 1.57 (1.18-2.09)). The primary findings were corroborated by sensitivity analysis. CONCLUSIONS Our study highlighted the need of public health preventive and educational programs in Italy, a country where the care pathway of lung cancer patients, especially in terms of diagnosis and mortality, appears to be negatively affected by SEP level.
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Affiliation(s)
- Michela Servadio
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Alessandro C Rosa
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy.
| | - Antonio Addis
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Ilaria Cozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | | | | | - Marina Davoli
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology, Regional Health Service Lazio, Rome, Italy
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Pickwell-Smith BA, Spencer K, Sadeghi MH, Greenley S, Lind M, Macleod U. Where are the inequalities in colorectal cancer care in a country with universal healthcare? A systematic review and narrative synthesis. BMJ Open 2024; 14:e080467. [PMID: 38171631 PMCID: PMC10773363 DOI: 10.1136/bmjopen-2023-080467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Patients diagnosed with colorectal cancer living in more deprived areas experience worse survival than those in more affluent areas. Those living in more deprived areas face barriers to accessing timely, quality healthcare. These barriers may contribute to socioeconomic inequalities in survival. We evaluated the literature for any association between socioeconomic group, hospital delay and treatments received among patients with colorectal cancer in the UK, a country with universal healthcare. DESIGN MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED and PsycINFO were searched from inception to January 2023. Grey literature, including HMIC, BASE and Google Advanced Search, and forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts and full-text articles. Observational UK-based studies were included if they reported socioeconomic measures and an association with either hospital delay or treatments received. The QUIPS tool assessed bias risk, and a narrative synthesis was conducted. The review is reported to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. RESULTS 41 of the 7209 identified references were included. 12 studies evaluated 7 different hospital intervals. There was a significant association between area-level deprivation and a longer time from first presentation in primary care to diagnosis. 32 studies evaluated treatments received. There were socioeconomic inequalities in surgery and chemotherapy but not radiotherapy. CONCLUSION Patients with colorectal cancer face inequalities across the cancer care continuum. Further research is needed to understand why and what evidence-based actions can reduce these inequalities in treatment. Qualitative research of patients and clinicians conducted across various settings would provide a rich understanding of the complex factors that drive these inequalities. Further research should also consider using a causal approach to future studies to considerably strengthen the interpretation. Clinicians can try and mitigate some potential causes of colorectal cancer inequalities, including signposting to financial advice and patient transport schemes. PROSPERO REGISTRATION NUMBER CRD42022347652.
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Affiliation(s)
| | - Katie Spencer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Michael Lind
- University of Hull, Hull, UK
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
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Vallome G, Cafaro I, Bottini A, Dellepiane C, Rossi G, Bennicelli E, Parisi F, Zullo L, Tagliamento M, Ballestrero A, Barisione E, Grazia Piroddi IM, Montecucco F, Carbone F, Pronzato P, Lambertini M, Spagnolo F, Barletta G, Barcellini L, Ferrante M, Nardin S, Coco S, Marconi S, Zinoli L, Moscatelli P, Arboscello E, Del Mastro L, Bellodi A, Genova C. Diagnosis of lung cancer following emergency admission: Examining care pathways, clinical outcomes, and advanced NSCLC treatment in an Italian cancer Center. Heliyon 2023; 9:e21177. [PMID: 37928020 PMCID: PMC10623281 DOI: 10.1016/j.heliyon.2023.e21177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023] Open
Abstract
Background Lung cancer patients diagnosed following emergency admission often present with advanced disease and poor performance status, leading to suboptimal treatment options and outcomes. This study aimed to investigate the clinical and molecular characteristics, treatment initiation, and survival outcomes of these patients. Methods We retrospectively analyzed data from 124 patients diagnosed with lung cancer following emergency admission at a single institution. Clinical characteristics, results of molecular analyses for therapeutic purpose, systemic treatment initiation, and survival outcomes were assessed. Correlations between patients' characteristics and treatment initiation were analyzed. Results Median age at admission was 73 years, and 79.0 % had at least one comorbidity. Most patients (87.1 %) were admitted due to cancer-related symptoms. Molecular analyses were performed in 89.5 % of advanced non-small cell lung cancer (NSCLC) cases. In this subgroup, two-thirds (66.2 %) received first-line therapy. Median overall survival (OS) was 3.9 months for the entire cohort, and 2.9 months for patients with metastatic lung cancer. Among patients with advanced NSCLC, OS was significantly longer for those with actionable oncogenic drivers and those who received first-line therapy. Improvement of performance status during hospitalization resulted in increased probability of receiving first-line systemic therapy. Discussion Patients diagnosed with lung cancer following emergency admission demonstrated poor survival outcomes. Treatment initiation, particularly for patients with actionable oncogenic drivers, was associated with longer OS. These findings highlight the need for proactive medical approaches, including improving access to molecular diagnostics and targeted treatments, to optimize outcomes in this patient population.
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Affiliation(s)
- Giacomo Vallome
- U.O. Oncologia Medica, Ospedale Padre Antero Micone, ASL3, Genoa, Italy
| | - Iacopo Cafaro
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Annarita Bottini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Chiara Dellepiane
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanni Rossi
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Bennicelli
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Parisi
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lodovica Zullo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Alberto Ballestrero
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Emanuela Barisione
- U.O. Pneumologia a Indirizzo Interventistico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italian Cardiovascular Network, Genoa, Italy
| | - Paolo Pronzato
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Spagnolo
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genoa, Genoa, Italy
| | - Giulia Barletta
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucrezia Barcellini
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Michele Ferrante
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Nardin
- U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simona Coco
- UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Marconi
- UO Tumori Polmonari, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Linda Zinoli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paolo Moscatelli
- UO Medicina Interna, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Eleonora Arboscello
- Dipartimento di Emergenza Urgenza e Accettazione (DEA), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Bellodi
- U.O. Clinica di Medicina Interna a Indirizzo Oncologico, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Genova
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy
- U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Afonso Gomes I, Moita B, Nunes C. Spatiotemporal Analysis of Breast Cancer Hospitalizations in Portugal in 2002–2016. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2020. [DOI: 10.1159/000508634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kembou Nzale S, Weeks WB, Ouafik L, Rouquette I, Beau-Faller M, Lemoine A, Bringuier PP, Le Coroller Soriano AG, Barlesi F, Ventelou B. Inequity in access to personalized medicine in France: Evidences from analysis of geo variations in the access to molecular profiling among advanced non-small-cell lung cancer patients: Results from the IFCT Biomarkers France Study. PLoS One 2020; 15:e0234387. [PMID: 32609781 PMCID: PMC7329126 DOI: 10.1371/journal.pone.0234387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/26/2020] [Indexed: 11/19/2022] Open
Abstract
In this article, we studied geographic variation in the use of personalized genetic testing for advanced non-small cell lung cancer (NSCLC) and we evaluated the relationship between genetic testing rates and local socioeconomic and ecological variables. We used data on all advanced NSCLC patients who had a genetic test between April 2012 and April 2013 in France in the frame of the IFCT Biomarqueurs-France study (n = 15814). We computed four established measures of geographic variation of the sex-adjusted rates of genetic testing utilization at the "départment" (the French territory is divided into 94 administrative units called 'départements') level. We also performed a spatial regression model to determine the relationship between département-level sex-adjusted rates of genetic testing utilization and economic and ecological variables. Our results are the following: (i) Overall, 46.87% lung cancer admission patients obtained genetic testing for NSCLC; département-level utilization rates varied over 3.2-fold. Measures of geographic variation indicated a relatively high degree of geographic variation. (ii) there was a statistically significant relationship between genetic testing rates and per capita supply of general practitioners, radiotherapists and surgeons (negative correlation for the latter); lower genetic testing rates were also associated with higher local poverty rates. French policymakers should pursue effort toward deprived areas to obtain equal access to personalized medicine for advanced NSCLC patients.
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Affiliation(s)
- Samuel Kembou Nzale
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
| | - William B. Weeks
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Building, DHMC, Lebanon, NH, United States of America
| | - L’Houcine Ouafik
- Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, Aix-Marseille Univ, Marseille, France
| | - Isabelle Rouquette
- Institut Universitaire du Cancer de Toulouse, Oncopôle, Service d'Anatomie Pathologique, Toulouse, France
| | - Michèle Beau-Faller
- Centre Hospitalier Universitaire de Hautepierre, Laboratoire de Biochimie et de Biologie Moléculaire & Plate-forme de Génomique des Cancers, Strasbourg, France
| | - Antoinette Lemoine
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Paris-Sud, Service d'Oncogénétique- Oncomolpath, Université Paris 11, Villejuif, France
| | - Pierre-Paul Bringuier
- Hôpital Edouard Herriot, Service d'Anatomie et de Cytologie Pathologique, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon Cancer Research Center, UMR 1057 INSERM, Lyon, France
| | - Anne-Gaëlle Le Coroller Soriano
- Mixed Research Unit 912, Institute of Research and Development, National Institute of Health and Medical Research, Paoli Calmettes Institute, Aix-Marseille University, Marseille, France
- * E-mail:
| | - Fabrice Barlesi
- Assistance Publique Hôpitaux de Marseille, Multidisciplinary Oncology and Therapeutic Innovations Department, Aix-Marseille Univ, Centre d'Investigation Clinique, Marseille, France
| | - Bruno Ventelou
- Aix-Marseille Univ., CNRS, EHESS, Centrale Marseille, AMSE, Marseille, France
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Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis. Front Oncol 2018; 8:536. [PMID: 30542641 PMCID: PMC6277796 DOI: 10.3389/fonc.2018.00536] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival. Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures. Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis. Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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McCormick B, Hill PS, Redding S. Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data. BMJ Open 2018; 8:e022573. [PMID: 30127052 PMCID: PMC6104760 DOI: 10.1136/bmjopen-2018-022573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Various studies find that the share of emergencies in hospital admissions is higher in deprived areas, but both the explanation and policy implications are unclear. We estimate the extent to which this finding is due to a different disease mix in deprived areas, rather than other explanations such as patient behaviour and general practitioner effectiveness. DESIGN Secondary analysis using English Hospital Episode Statistics data, with disease for elective and emergency admissions in 2008/2009 coded at 186 blocks or 1230 categories and aggregated to lower layer super output area of residence. It is then linked to an appropriate measure of deprivation. OUTCOME MEASURES The difference in the share of emergencies in hospital admissions between communities in the highest and lowest deciles of deprivation; and the percentage of this difference that is explained if areas in the least deprived decile have the same disease mix as those in the most deprived decile. RESULTS Using the finest disease classification scheme (1230 categories), 71% of the higher share of admissions that were emergencies in decile 1 areas relative to decile 10, is explained by the "adverse" case mix (CM) in deprived areas. The remainder reflects the higher relative use of emergency care in deprived areas for the same conditions. Higher incidence of respiratory and circulatory diseases in deprived areas explains about 30% of the CM contribution. Diseases of the digestive system and abdomen have a high relative use of emergency care in deprived areas. CONCLUSIONS The higher use of emergency care in deprived areas is primarily a symptom of the higher prevalence of diseases which have high national rates of emergency to elective care-especially respiratory diseases-rather than an indication of less effective primary care. Nevertheless, there is a higher share of emergency care in admissions in deprived areas for several diseases, most notably of the digestive system.
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Affiliation(s)
- Barry McCormick
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter-Sam Hill
- Education Portfolio, Oxford Policy Management, Oxford, UK
| | - Stuart Redding
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Maringe C, Rachet B, Lyratzopoulos G, Rubio FJ. Persistent inequalities in unplanned hospitalisation among colon cancer patients across critical phases of their care pathway, England, 2011-13. Br J Cancer 2018; 119:551-557. [PMID: 30108292 PMCID: PMC6162238 DOI: 10.1038/s41416-018-0170-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/05/2018] [Accepted: 06/13/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reducing hospital emergency admissions is a key target for all modern health systems. METHODS We analysed colon cancer patients diagnosed in 2011-13 in England. We screened their individual Hospital Episode Statistics records in the 90 days pre-diagnosis, the 90 days post-diagnosis, and the 90 days pre-death (in the year following diagnosis), for the occurrence of hospital emergency admissions (HEAs). RESULTS Between a quarter and two thirds of patients experience HEA in the three 90-day periods examined: pre-diagnosis, post-diagnosis and before death. Patients with tumour stage I-III from more deprived backgrounds had higher proportions of HEAs than less deprived patients during all studied periods. This remains even after adjusting for differing distributions of risk factors such as age, sex, comorbidity and stage at diagnosis. CONCLUSIONS Although in some cases HEAs might be unavoidable or even appropriate, the proportion of HEAs varies by socioeconomic status, even after controlling for the usual patient factors, suggestive of remediable causes of excess emergency healthcare utilisation in patients belonging to higher deprivation groups. Future inquiries should address the potential role of clinical complications, sub-optimal healthcare administration, premature discharge or a lack of social support as potential explanations for these patterns of inequality.
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Affiliation(s)
- Camille Maringe
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Bernard Rachet
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, WC1E 7HB, UK
| | - Francisco Javier Rubio
- Cancer Survival Group, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
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Vallance AE, van der Meulen J, Kuryba A, Braun M, Jayne DG, Hill J, Cameron IC, Walker K. Socioeconomic differences in selection for liver resection in metastatic colorectal cancer and the impact on survival. Eur J Surg Oncol 2018; 44:1588-1594. [PMID: 29895508 DOI: 10.1016/j.ejso.2018.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/02/2018] [Accepted: 05/17/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in colorectal cancer (CRC) survival are well recognised. The aim of this study was to describe the impact of socioeconomic deprivation on survival in patients with synchronous CRC liver-limited metastases, and to investigate if any survival inequalities are explained by differences in liver resection rates. METHODS Patients in the National Bowel Cancer Audit diagnosed with CRC between 2010 and 2016 in the English National Health Service were included. Linked Hospital Episode Statistics data were used to identify the presence of liver metastases and whether a liver resection had been performed. Multivariable random-effects logistic regression was used to estimate the odds ratio (OR) of liver resection by Index of Multiple Deprivation (IMD) quintile. Cox-proportional hazards model was used to compare 3-year survival. RESULTS 13,656 patients were included, of whom 2213 (16.2%) underwent liver resection. Patients in the least deprived IMD quintile were more likely to undergo liver resection than those in the most deprived quintile (adjusted OR 1.42, 95% confidence interval (CI) 1.18-1.70). Patients in the least deprived quintile had better 3-year survival (least deprived vs. most deprived quintile, 22.3% vs. 17.4%; adjusted hazard ratio (HR) 1.20, 1.11-1.30). Adjusting for liver resection attenuated, but did not remove, this effect. There was no difference in survival between IMD quintile when restricted to patients who underwent liver resection (adjusted HR 0.97, 0.76-1.23). CONCLUSIONS Deprived CRC patients with synchronous liver-limited metastases have worse survival than more affluent patients. Lower rates of liver resection in more deprived patients is a contributory factor.
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Affiliation(s)
- A E Vallance
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
| | - J van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Kuryba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - M Braun
- Christie NHS Foundation Trust, Manchester, UK
| | - D G Jayne
- The John Goligher Colorectal Surgery Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Hill
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - I C Cameron
- Department of Hepatobiliary and Pancreatic Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Walker
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Saxena S, George J, Barber J, Fitzpatrick J, Majeed A. Association of Population and Practice Factors with pOtentially Avoidable Admission Rates for Chronic Diseases in London: Cross Sectional Analysis. J R Soc Med 2017; 99:81-9. [PMID: 16449782 PMCID: PMC1360495 DOI: 10.1177/014107680609900221] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. DESIGN Cross sectional analysis at primary care trusts level using routine data from multiple sources. SETTING All 31 primary care trusts in London with a total resident population of 7 million patients. MAIN OUTCOME MEASURES Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. RESULTS Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. CONCLUSIONS Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.
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Affiliation(s)
- Sonia Saxena
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP.
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Peconi J, Macey S, Rodgers S, Russell I, Snooks H, Watkins A. Advice given by NHS Direct in Wales: do deprived patients get more urgent decisions? Study of routine data. J Epidemiol Community Health 2017; 71:jech-2017-208978. [PMID: 28733459 PMCID: PMC5561357 DOI: 10.1136/jech-2017-208978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 06/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND In the UK, National Health Service Direct Wales (NHSDW) uses computerised decision support software to advise patients on appropriate care. However, the effect of deprivation on the advice given is not known. We aimed to estimate the effect of deprivation on advice given by nurses in NHSDW adjusting for confounding variables. METHODS We included 400 000 calls to NHSDW between January 2002 and June 2004. We used logistic regression to model the effect of deprivation on advice given by nurses in response to calls seeking advice or information. We analysed two outcomes: receiving advice to phone 999 emergency care rather than to seek other care and receiving advice to seek care face to face rather than self-care. RESULTS After adjustment for covariates, an increase in deprivation from one-fifth of the distribution to the next fifth increased by 13% the probability that those calling for advice rather than information received advice to phone 999 (OR 1.127; 95% CI from 1.113 to 1.143). Deprivation increased the corresponding probability of being advised to seek care face to face rather than self-care by 5% (OR 1.049; 95% CI from 1.041 to 1.058) within advice calls and by 3% (OR 1.034; 95% CI from 1.022 to 1.047) within information calls. CONCLUSIONS Deprivation increased the chance of receiving more urgent advice, particularly advice to call 999. While our dataset may underestimate the 'need' of deprived patients, it yields no evidence of major inequity in advice given to these patients.
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Affiliation(s)
- Julie Peconi
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Steven Macey
- Action on Smoking and Health (ASH) Wales, Cardiff, UK
| | - Sarah Rodgers
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Ian Russell
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
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Jiang X, Lin G, Islam KM. Socioeconomic factors related to surgical treatment for localized, non-small cell lung cancer. Soc Sci Med 2017; 175:52-57. [DOI: 10.1016/j.socscimed.2016.12.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
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Solsky I, Friedmann P, Muscarella P, In H. Poor Outcomes of Gastric Cancer Surgery After Admission Through the Emergency Department. Ann Surg Oncol 2016; 24:1180-1187. [PMID: 27909825 DOI: 10.1245/s10434-016-5696-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Outcomes after nonelective surgery for gastric cancer (GC) are poorly defined. Our objective was to compare outcomes of patients undergoing nonelective GC surgery after admission through the emergency department (EDSx) with patients receiving elective surgery or surgery after planned admission (non-EDSx) nationally. METHODS The Nationwide Inpatient Sample (NIS) database was used to examine patients undergoing GC surgery between 2008 and 2012. Demographics and outcomes were compared between EDSx and non-EDSx. Multivariable logistic regression was used to examine predictors of discharge to home. RESULTS Of 9279 patients, 1143 (12%) underwent EDSx. They were more likely to be female (42 vs. 35%), nonwhite (56 vs. 33%), aged ≥75 years (40 vs. 26%), in the lowest quartile for household income (31 vs. 25%), have one or more comorbidities (87 vs. 70%), treated at a nonteaching hospital (46 vs. 25%), and have a concomitant diagnosis of obstruction, perforation, or bleeding (30 vs. 6%). They had longer total length of stay (LOS; 16 vs. 9 days), longer median postoperative stays (10 vs. 9 days), higher in-hospital mortality (8 vs. 3%), and were less likely to be discharged home (63 vs. 82%). EDSx was more expensive ($125,300 vs. $83,604). EDSx was associated with a lower likelihood of discharge to home (odds ratio 0.52, 95% CI 0.43-0.62). CONCLUSIONS Nationally, 12% of GC surgeries are performed after emergency department admission, which occurs more frequently in vulnerable populations and results in worse outcomes. Understanding factors leading to increased EDSx and developing strategies to decrease EDSx may improve GC surgery outcomes.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Patricia Friedmann
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter Muscarella
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Forrest LF, Sowden S, Rubin G, White M, Adams J. Socio-economic inequalities in stage at diagnosis, and in time intervals on the lung cancer pathway from first symptom to treatment: systematic review and meta-analysis. Thorax 2016; 72:430-436. [PMID: 27682330 DOI: 10.1136/thoraxjnl-2016-209013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
Abstract
Cancer diagnosis at an early stage increases the chance of curative treatment and of survival. It has been suggested that delays on the pathway from first symptom to diagnosis and treatment may be socio-economically patterned, and contribute to socio-economic differences in receipt of treatment and in cancer survival. This review aimed to assess the published evidence for socio-economic inequalities in stage at diagnosis of lung cancer, and in the length of time spent on the lung cancer pathway. MEDLINE, EMBASE and CINAHL databases were searched to locate cohort studies of adults with a primary diagnosis of lung cancer, where the outcome was stage at diagnosis or the length of time spent within an interval on the care pathway, or a suitable proxy measure, analysed according to a measure of socio-economic position. Meta-analysis was undertaken when there were studies available with suitable data. Of the 461 records screened, 39 papers were included in the review (20 from the UK) and seven in a final meta-analysis for stage at diagnosis. There was no evidence of socio-economic inequalities in late stage at diagnosis in the most, compared with the least, deprived group (OR=1.04, 95% CI=0.92 to 1.19). No socio-economic inequalities in the patient interval or in time from diagnosis to treatment were found. Socio-economic inequalities in stage at diagnosis are thought to be an important explanatory factor for survival inequalities in cancer. However, socio-economic inequalities in stage at diagnosis were not found in a meta-analysis for lung cancer. PROSPERO PROTOCOL REGISTRATION NUMBER CRD42014007145.
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Affiliation(s)
- Lynne F Forrest
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Sowden
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK
| | - Greg Rubin
- Fuse, UKCRC Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, UK.,Wolfson Research Institute, Durham University, Queen's Campus, Stockton on Tees, UK
| | - Martin White
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedicine Campus, Cambridge, UK
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Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Cruz-Correa M, Ortiz AP. Factors associated with late stage at diagnosis among Puerto Rico's government health plan colorectal cancer patients: a cross-sectional study. BMC Health Serv Res 2016; 16:344. [PMID: 27488381 PMCID: PMC4971714 DOI: 10.1186/s12913-016-1590-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 07/27/2016] [Indexed: 11/13/2022] Open
Abstract
Background Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico’s Government Health Plan (GHP) patients. Methods We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study. Results There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage. Conclusions These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient’s pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. .,Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Marcia Cruz-Correa
- Department of Surgery, Biochemistry and Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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16
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Ursem CJ, Bosworth HB, Shelby RA, Hwang W, Anderson RT, Kimmick GG. Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income. J Womens Health (Larchmt) 2015; 24:403-8. [PMID: 25884292 DOI: 10.1089/jwh.2014.4982] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are wide disparities in breast cancer-specific survival by patient sociodemographic characteristics. Women of lower income, for instance, have higher relapse and death rates from breast cancer. One possible contributing factor for this disparity is low use of adjuvant endocrine therapy-an extremely efficacious therapy in women with early stage, hormone receptor positive breast cancer, the most common subtype of breast cancer. Alone, adjuvant endocrine therapy decreases breast cancer recurrence by 50% and death by 30%. Data suggest that low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome in low-income breast cancer patients.
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Affiliation(s)
- Carling J Ursem
- 1 Department of Hematology and Oncology, UCSF , San Francisco, California
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Abstract
OBJECTIVE To identify patient and practitioner factors that influence cancer diagnosis via emergency presentation (EP). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL, EBM Reviews, Science and Social Sciences Citation Indexes, Conference Proceedings Citation Index-Science and Conference Proceedings Citation Index-Social Science and Humanities. Searches were undertaken from 1996 to 2014. No language restrictions were applied. STUDY SELECTION Studies of any design assessing factors associated with diagnosis of colorectal or lung cancer via EP, or describing an intervention to impact on EP, were included. Studies involving previously diagnosed cancer patients, assessing only referral pathway effectiveness, outcomes related to diagnosis or post-EP management were excluded. The population was individual or groups of adult patients or primary care practitioners. Two authors independently screened studies for inclusion. RESULTS 22 studies with over 200,000 EPs were included, most providing strong evidence. Five were graded 'insufficient', primarily due to missing information rather than methodological weakness. Older patient age was associated with EP for lung and colorectal cancers (OR 1.11-11.03 and 1.19-5.85, respectively). Women were more at risk of EP for lung but not colorectal cancer. Higher deprivation increased the likelihood of lung cancer EP, but evidence for colorectal was less conclusive. Being unmarried (or divorced/widowed) increased the likelihood of EP for colorectal cancer, which was also associated with pain, obstruction and weight loss. Lack of a regular source of primary care, and lower primary care use were positively associated with EP. Only three studies considered practitioner factors, two involving diagnostic tests. No conclusive evidence was found. CONCLUSIONS Patient-related factors, such as age, gender and deprivation, increase the likelihood of cancer being diagnosed as the result of an EP, while cancer symptoms and patterns of healthcare utilisation are also relevant. Further work is needed to understand the context in which risk factors for EP exist and influence help-seeking.
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Affiliation(s)
- Elizabeth D Mitchell
- Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Una Macleod
- Supportive Care, Early Diagnosis and Advanced disease (SEDA) Research Group, Centre for Health and Population Sciences, Hull York Medical School, University of Hull, Hull, UK
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Pruitt SL, Davidson NO, Gupta S, Yan Y, Schootman M. Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery. BMC Cancer 2014; 14:927. [PMID: 25491412 PMCID: PMC4364088 DOI: 10.1186/1471-2407-14-927] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/26/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Disparities by race and neighborhood socioeconomic status exist for many colorectal cancer (CRC) outcomes, including screening use and mortality. We used population-based data to determine if disparities also exist for emergency CRC diagnosis and surgery. METHODS We examined two emergency CRC outcomes using 1992-2005 population-based U.S. SEER-Medicare data. Among CRC patients aged ≥66 years, we examined racial (African American vs. white) and neighborhood poverty disparities in two emergency outcomes defined as: 1) newly diagnosed CRC or 2) CRC surgery associated with: obstruction, perforation, or emergency inpatient admission. Multilevel logistic regression (patients nested in census tracts) analyses adjusted for sociodemographic, tumor, and clinical covariates. RESULTS Of 83,330 CRC patients, 29.1% were diagnosed emergently. Of 55,046 undergoing surgery, 26.0% had emergency surgery. For both outcomes, race and neighborhood poverty disparities were evident. A significant race by poverty interaction (p < .001) was noted: poverty rate was associated with both outcomes among African Americans, but not whites. Compared to whites in low poverty (<10%) neighborhoods, African Americans in high poverty (≥20%) neighborhoods had increased odds of emergency diagnosis (AOR: 1.50, 95% CI: 1.38-1.63) and surgery (AOR: 1.63, 95% CI: 1.47-1.81). CONCLUSIONS Emergency CRC outcomes are associated with high poverty residence among African Americans in this population-based study, potentially contributing to observed disparities in CRC morbidity and mortality. Targeted efforts to increase CRC screening among African Americans living in high poverty neighborhoods could reduce preventable disparities.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd E1, 410D Dallas, TX, USA.
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Identifying patients at risk of emergency admission for colorectal cancer. Br J Cancer 2014; 111:577-80. [PMID: 24921910 PMCID: PMC4119975 DOI: 10.1038/bjc.2014.300] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/11/2014] [Accepted: 05/12/2014] [Indexed: 01/22/2023] Open
Abstract
Background: Patients whose colorectal cancer is treated after an emergency admission tend to have late-stage cancer and a poor prognosis. We identified risk factors for an emergency admission by linking data from the National Bowel Cancer Audit (NBCA) and the English Hospital Episode Statistics (HES), an administrative database of all admissions to English National Health Service hospitals, which includes data on mode of admission. Methods: We identified all adults included in the NBCA with a primary diagnosis of bowel cancer, excluding cancer of the appendix, between August 2007 and July 2011 whose record could be linked to HES. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) for an emergency admission for colorectal cancer. All risk factors were adjusted for cancer site and calendar year. Results: 97 909 adults were identified with a primary diagnosis of bowel cancer and 82 777 patients could be linked to HES. Patients who were older, female, of a non-white ethnic background, and more socioeconomically deprived, and those with dementia or cardiac, neurologic and liver disease had an increased risk of presenting as an emergency admission. The strongest risk factors were age (90 compared with 70 years: OR 2.99, 95% CI 2.84 to 3.15), dementia (OR 2.46, 2.18 to 2.79), and liver disease (OR 1.87, 1.69 to 2.08). Conclusions: Our study identifies risk factors that may impair health-seeking behaviour and access to healthcare. An earlier recognition of symptoms in patients with these risk factors may contribute to better outcomes.
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Shawihdi M, Thompson E, Kapoor N, Powell G, Sturgess RP, Stern N, Roughton M, Pearson MG, Bodger K. Variation in gastroscopy rate in English general practice and outcome for oesophagogastric cancer: retrospective analysis of Hospital Episode Statistics. Gut 2014; 63:250-61. [PMID: 23426895 DOI: 10.1136/gutjnl-2012-304202] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To determine whether variation in gastroscopy rates in English general practice populations is associated with inequality in oesophagogastric (OG) cancer outcome. DESIGN Retrospective observational study of the Hospital Episode Statistics (HES) dataset for England (2006-2008) linked to death registration. METHODS were validated using independent local and national data. General practices with new cases of OG cancer were included. Practices were grouped into tertiles according to standardised elective gastroscopy rate per capita (low, medium or high). Outcome measures for cancer cases were: emergency admission during diagnostic pathway, major surgical resection and mortality at 1 year. Covariates were: age group, gender, comorbidity, general practice average deprivation and patient deprivation. RESULTS 22 488 incident cases of OG cancer from 6513 general practices were identified. Patients registered with the low tertile group of practices had the lowest rate of major surgery, highest rate of emergency admission and highest mortality. The inequality was widest for the most socioeconomically deprived cases. After adjustment for covariates in logistic regression, the gastroscopy rate (low, medium or high) at the patient's general practice was an independent predictor of emergency admission, major surgery and mortality. CONCLUSIONS There is wide variation in the rate of gastroscopy among general practice populations in England. On average, OG cancer patients belonging to practices with the lowest rates of gastroscopy are at greater risk of poor outcome. These findings suggest that initiatives or current guidelines aimed at limiting the use of gastroscopy may adversely affect cancer outcomes.
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Affiliation(s)
- Mustafa Shawihdi
- Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, UK
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Mungrue K, Ramdath J, Ali S, Cuffie WA, Dodough N, Gangar M, Mohammed L, Mungroo V, Ramsahai J, Shah M. Challenges to the control of breast cancer in a small developing country. Breast Cancer (Auckl) 2014; 8:7-13. [PMID: 24526837 PMCID: PMC3921156 DOI: 10.4137/bcbcr.s12780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the clinicopathological features of breast cancer in two dedicated cancer treatment centers in north Trinidad. The histological types and stage at presentation were also investigated. DESIGN AND METHODS A retrospective cohort design was used; data were collected from a review of medical records of patients meeting the entry criteria. Clinical and demographic data were extracted. RESULTS A total of 640 patients were selected for the study and were available for the analysis. The annual cumulative incidence rate of breast cancer for the calendar years 2010 and 2011 in north Trinidad was 32.4 per 100,000 and 24.6 per 100,000 of the population. The age group between 51-60 years had the highest proportion of cases of breast cancer. There was a significant ethnic disparity in the occurrence of breast cancer, as it was more common in people of African origin than among South East Asians. Surgery and chemotherapy were the major interventions employed. CONCLUSION Breast cancer prevalence continues to be high in Trinidad; we provide evidence of the extent of and the degree of sophistication required to care for patients with breast cancer in a health care system in a small developing country.
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Affiliation(s)
- Kameel Mungrue
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Jeremy Ramdath
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Siddiq Ali
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Winsie-Ann Cuffie
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Nicholas Dodough
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Misty Gangar
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Laura Mohammed
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Vikash Mungroo
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Justin Ramsahai
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
| | - Mariyah Shah
- University of the West Indies, Faculty of Medical Sciences, Department of Paraclinical Sciences, EMWSC, Mount Hope, Trinidad
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Abstract
Since the mid-90s UK governments and other policy makers have sought to develop policy that addresses the need for improved outcomes for people diagnosed with cancer. However, the strategies for cancer in Scotland, Wales and Northern Ireland are different to the policy on cancer produced under the English government. This article will examine policy developments in the English health service aimed at achieving early diagnosis of cancer with particular reference to the Cancer Reform Strategy (2007). The role of socioeconomic factors and the need for policy to address a range of cancers due to their differences in pathology and therefore diagnosis and treatment will also be considered.
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Gunnarsson H, Ekholm A, Olsson LI. Emergency presentation and socioeconomic status in colon cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2013; 39:831-6. [PMID: 23692701 DOI: 10.1016/j.ejso.2013.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 03/10/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Emergency presentation affects up to every fourth patient with colon cancer, and is associated with worse outcomes. The aim of this study was to investigate any association between socioeconomic status (SES) and mode of presentation in colon cancer. MATERIALS AND METHODS Individually attained data on civil status, education and income were linked to quality registries for colon cancer in two large Swedish regions 1997-2006 (n = 12 293) and analyzed by logistic regression, adjusting for age, sex, stage, region and socioeconomic variables. RESULTS The frequency of emergency presentation was 23%; 27.8% among patients above the age of 80, and 20.0% among patients aged 70-79 (p < 0.001). There was no difference between men and women (22.6% vs. 23.8%; p = 0.1). Among patients with stage IV colon cancer, 34.6% presented as emergencies. Odds ratio for an emergency presentation in unmarried patients was 1.24 (96% CI 1.04-1.48), and for unmarried patients above the age of 80, OR was 1.45 (95% CI 0.98-2.13). Among patients below the age of 70 with compulsory education only, OR was 1.22 (95% CI 0.98-1.48). For patients within the lowest income quartile (Q1), OR was 1.24 (95% CI 1.04-1.49). This was most pronounced in men (OR 1.34; 95% CI 1.40-1.72), in patients below the age of 70 (OR 1.36; 95% CI 1.02-1.82), and above the age of 80 (OR 1.41; 95% CI 1.00-1.98). CONCLUSION Emergency presentation of colon cancer is consistently associated with socioeconomic factors, and this must be considered in efforts aimed at reducing the overall frequency of emergency cases.
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Affiliation(s)
- H Gunnarsson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Sweden.
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Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis. PLoS Med 2013; 10:e1001376. [PMID: 23393428 PMCID: PMC3564770 DOI: 10.1371/journal.pmed.1001376] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intervention-generated inequalities are unintended variations in outcome that result from the organisation and delivery of health interventions. Socioeconomic inequalities in treatment may occur for some common cancers. Although the incidence and outcome of lung cancer varies with socioeconomic position (SEP), it is not known whether socioeconomic inequalities in treatment occur and how these might affect mortality. We conducted a systematic review and meta-analysis of existing research on socioeconomic inequalities in receipt of treatment for lung cancer. METHODS AND FINDINGS MEDLINE, EMBASE, and Scopus were searched up to September 2012 for cohort studies of participants with a primary diagnosis of lung cancer (ICD10 C33 or C34), where the outcome was receipt of treatment (rates or odds of receiving treatment) and where the outcome was reported by a measure of SEP. Forty-six papers met the inclusion criteria, and 23 of these papers were included in meta-analysis. Socioeconomic inequalities in receipt of lung cancer treatment were observed. Lower SEP was associated with a reduced likelihood of receiving any treatment (odds ratio [OR] = 0.79 [95% CI 0.73 to 0.86], p<0.001), surgery (OR = 0.68 [CI 0.63 to 0.75], p<0.001) and chemotherapy (OR = 0.82 [95% CI 0.72 to 0.93], p = 0.003), but not radiotherapy (OR = 0.99 [95% CI 0.86 to 1.14], p = 0.89), for lung cancer. The association remained when stage was taken into account for receipt of surgery, and was found in both universal and non-universal health care systems. CONCLUSIONS Patients with lung cancer living in more socioeconomically deprived circumstances are less likely to receive any type of treatment, surgery, and chemotherapy. These inequalities cannot be accounted for by socioeconomic differences in stage at presentation or by differences in health care system. Further investigation is required to determine the patient, tumour, clinician, and system factors that may contribute to socioeconomic inequalities in receipt of lung cancer treatment.
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Quaglia A, Lillini R, Mamo C, Ivaldi E, Vercelli M. Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival. Crit Rev Oncol Hematol 2012; 85:266-77. [PMID: 22999326 DOI: 10.1016/j.critrevonc.2012.08.007] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/08/2011] [Accepted: 08/29/2012] [Indexed: 02/07/2023] Open
Abstract
During the past few decades, many studies on socio-economic factors and health outcomes have been developed using various methodologies with differing approaches. A bibliographic research in MEDLINE/PubMed and SCOPUS was carried out for the period 2000-2011 to describe the influence of socio-economic status (SES) on cancer survival, in particular with reference to the outcome of European research results and the results of some cases of other Western studies. This review is divided into two sections: the first describing the different approaches of the study on individuals and populations of the concept of "social class" as well as methods used to measure the association between deprivation and health (i.e. ecological level studies, deprivation indexes, etc.); and the second discussing the association between socio-economic factors and cancer survival, describing the roles of various determinants of differences in survival, such as clinical and pathological prognostic factors, together with consideration of diagnosis and treatment and some patients' characteristics.
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Affiliation(s)
- Alberto Quaglia
- U.O.S. Epidemiologia Descrittiva (Registro Tumori), IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
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Variation in surgical resection for lung cancer in relation to survival: Population-based study in England 2004–2006. Eur J Cancer 2012; 48:54-60. [DOI: 10.1016/j.ejca.2011.07.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 07/14/2011] [Accepted: 07/19/2011] [Indexed: 11/21/2022]
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Crawford SM, Sauerzapf V, Haynes R, Forman D, Jones AP. Social and geographical factors affecting access to treatment of colorectal cancer: a cancer registry study. BMJ Open 2012; 2:e000410. [PMID: 22535788 PMCID: PMC3341592 DOI: 10.1136/bmjopen-2011-000410] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Cancer outcomes vary between and within countries with patients from deprived backgrounds known to have inferior survival. The authors set out to explore the effect of deprivation in relation to the accessibility of hospitals offering diagnostic and therapeutic services on stage at presentation and receipt of treatment. DESIGN Analysis of a Cancer Registry Database. Data included stage and treatment details from the first 6 months. The socioeconomic status of the immediate area of residence and the travel time from home to hospital was derived from the postcode. SETTING Population-based study of patients resident in a large area in the north of England. PARTICIPANTS 39 619 patients with colorectal cancer diagnosed between 1994 and 2002. OUTCOMES MEASURED Stage of diagnosis and receipt of treatment in relation to deprivation and distance from hospital. RESULTS Patients in the most deprived quartile were significantly more likely to be diagnosed at stage 4 for rectal cancer (OR 1.516, p<0.05) but less so for colonic cancer. There was a trend for both sites for patients in the most deprived quartile to be less likely to receive chemotherapy for stage 4 disease. Patients with colonic cancer were very significantly less likely to receive any treatment if they came from any but the most affluent area (ORs 0.639, 0.603 and 0.544 in increasingly deprived quartiles), this may have been exacerbated if the hospital was distant from their residence (OR for forth quartile for both travel and deprivation 0.731, not significant). The effect was less for rectal cancer and no effect of distance was seen. CONCLUSIONS Residing in a deprived area is associated with tendencies to higher stage at diagnosis and especially in the case of colonic cancer to reduced receipt of treatment. These observations are consistent with other findings and indicate that access to diagnosis requires further investigation.
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Affiliation(s)
- S Michael Crawford
- Department of Medical Oncology, Airedale NHS Trust, Airedale General Hospital, Keighley, UK
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Møller H, Sandin F, Robinson D, Bray F, Klint Å, Linklater KM, Lambert PC, Påhlman L, Holmberg L, Morris E. Colorectal cancer survival in socioeconomic groups in England: Variation is mainly in the short term after diagnosis. Eur J Cancer 2012; 48:46-53. [DOI: 10.1016/j.ejca.2011.05.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/09/2011] [Accepted: 05/12/2011] [Indexed: 11/30/2022]
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Haas JS, Brawarsky P, Iyer A, Fitzmaurice GM, Neville BA, Earle C. Association of area sociodemographic characteristics and capacity for treatment with disparities in colorectal cancer care and mortality. Cancer 2011; 117:4267-76. [DOI: 10.1002/cncr.26034] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 11/23/2010] [Accepted: 01/03/2011] [Indexed: 11/10/2022]
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Quaglia A, Lillini R, Casella C, Giachero G, Izzotti A, Vercelli M. The combined effect of age and socio-economic status on breast cancer survival. Crit Rev Oncol Hematol 2011; 77:210-20. [DOI: 10.1016/j.critrevonc.2010.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 01/31/2010] [Accepted: 02/16/2010] [Indexed: 01/19/2023] Open
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Bastiaannet E, de Craen AJM, Kuppen PJK, Aarts MJ, van der Geest LGM, van de Velde CJH, Westendorp RGJ, Liefers GJ. Socioeconomic differences in survival among breast cancer patients in the Netherlands not explained by tumor size. Breast Cancer Res Treat 2010; 127:721-7. [PMID: 21076863 DOI: 10.1007/s10549-010-1250-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/27/2010] [Indexed: 11/24/2022]
Abstract
There seem to be socioeconomically differences in survival for females with breast cancer, usually associated with a higher stage of disease. However, differences within tumor size have not been studied. Aim of this study is to assess differences in survival according to socioeconomic status (SES), stratified for tumor size and stage at diagnosis, for females with breast cancer in the Netherlands. All females diagnosed with breast cancer (1995-2005) were selected from the Netherlands Cancer Registry. Patients were linked to a SES database according to postal code. A multivariable logistic regression was used to assess factors associated with SES. Overall survival (OS) and relative survival (RS) were calculated. Overall, 127,599 patients were included. Higher SES was associated with lower T-stage (P < 0.0001). A decreased survival (OS and RS) was found for patients with a lower SES. Also within different size groups, RS was different. Overall, 10-year OS for the high SES group was 65 and 58% for the low SES group (hazard ratio 1.1, P < 0.001) and RS was 79 versus 74% (relative excess risk, RER 1.2; P < 0.001). The socioeconomic differences remained statistically significant (P < 0.001) after adjustment for age, year of diagnosis, grade, TNM stage, and treatment. For the lowest SES group 777 deaths could be avoided. Socioeconomic differences in survival of breast cancer patients were observed in the Netherlands. Higher stage at diagnosis of patients with a lower SES only partly explains the decreased survival. Policies aimed at the reduction of socioeconomic health inequalities might be important to improve survival of breast cancer.
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Affiliation(s)
- E Bastiaannet
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Thorne K, Hutchings HA, Elwyn G. An independent evaluation of the modernization of NHS endoscopy services in England: data poverty and no improvement. J Eval Clin Pract 2010; 16:693-9. [PMID: 20545807 DOI: 10.1111/j.1365-2753.2009.01177.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Modernising Endoscopy Services (MES) programme introduced a focussed modernization drive and data collection regime to English NHS endoscopy services. We independently evaluated the MES programme by comparing routinely collected, service-related endoscopy data from sites that participated in the MES programme and sites that did not. METHODS A random selection of 10 endoscopy units who had participated in the MES programme (intervention sites) were compared with a random selection of 10 endoscopy units who redesigned their services independently (control sites). Data on demand, numbers waiting, activity and cancellations were collected for eight time points between January 2003 and April 2006. Data were aggregated into intervention and control groups for statistical analysis using a two-way analysis of variance. Activity data were validated using an equivalent Hospital Episode Statistics dataset. RESULTS Data were not routinely collected by 11 of 19 endoscopy units. Trust-held datasets were subsequently included to address problems with data availability. The accuracy of the Activity data was successfully validated. Statistical analysis of the data showed that neither the intervention group nor the control group were able to significantly improve their services over time. There was also no significant difference between the intervention group and the control group in the improvement of their endoscopy services at any point time. CONCLUSIONS Based on the data collected, the intervention programme did not significantly improve NHS endoscopy services in England over and above what could have been achieved independently with only the intention to redesign.
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Affiliation(s)
- Kymberley Thorne
- Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, Swansea University, Singleton Park, Swansea, UK.
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Raine R, Wong W, Scholes S, Ashton C, Obichere A, Ambler G. Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics. BMJ 2010; 340:b5479. [PMID: 20075152 PMCID: PMC2806941 DOI: 10.1136/bmj.b5479] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer. DESIGN Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006. SETTING Hospital episode statistics (HES) dataset. PARTICIPANTS 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer. MAIN OUTCOME MEASURES Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment. RESULTS Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0.52 (0.46 to 0.59). Conclusions Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision of care.
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Affiliation(s)
- Rosalind Raine
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT.
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Dias SS, Andreozzi V, Martins MO, Torgal J. Predictors of mortality in HIV-associated hospitalizations in Portugal: a hierarchical survival model. BMC Health Serv Res 2009; 9:125. [PMID: 19627574 PMCID: PMC2725041 DOI: 10.1186/1472-6963-9-125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 07/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The beneficial effects of highly active antiretroviral therapy, increasing survival and the prevention of AIDS defining illness development are well established. However, the annual Portuguese hospital mortality is still higher than expected. It is crucial to understand the hospitalization behaviour to better allocate resources. This study investigates the predictors of mortality in HIV associated hospitalizations in Portugal through a hierarchical survival model. METHODS The study population consists of 12,078 adult discharges from patients with HIV infection diagnosis attended at Portuguese hospitals from 2005-2007 that were registered on the diagnosis-related groups' database.We used discharge and hospital level variables to develop a hierarchical model. The discharge level variables were: age, gender, type of admission, type of diagnoses-related group, related HIV complication, the region of the patient's residence, the number of diagnoses and procedures, the Euclidean distance from hospital to the centroid of the patient's ward, and if patient lived in the hospital's catchment area. The hospital characteristics include size and hospital classification according to the National Health System. Kaplan-Meier plots were used to examine differences in survival curves. Cox proportional hazard models with frailty were applied to identify independent predictors of hospital mortality and to calculate hazard ratios (HR). RESULTS The Cox proportional model with frailty showed that male gender, older patient, great number of diagnoses and pneumonia increased the hazard of HIV related hospital mortality. On the other hand tuberculosis was associated with a reduced risk of death. Central hospital discharge also presents less risk of mortality.The frailty variance was small but statistically significant, indicating hazard ratio heterogeneity among hospitals that varied between 0.67 and 1.34, and resulted in two hospitals with HR different from the average risk. CONCLUSION The frailty model suggests that there are unmeasured factors affecting mortality in HIV associated hospitalizations. Consequently, for healthcare policy purposes, hospitals should not all be treated in an equal manner.
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Affiliation(s)
- Sara S Dias
- Higher Institute of Statistics and Information Management, New University of Lisbon, Lisbon, Portugal.
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Barbour KE, Fabio A, Pearlman DN. Inpatient charges among HIV/AIDS patients in Rhode Island from 2000-2004. BMC Health Serv Res 2009; 9:3. [PMID: 19128494 PMCID: PMC2630923 DOI: 10.1186/1472-6963-9-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inpatient HIV/AIDS charges decreased from 1996-2000. This decrease was mainly attributable to treatment of HIV/AIDS patients with Highly Active Antiretroviral Therapy (HAART). This study aims to evaluate the trend in inpatient charges from 2000-2004. METHODS Rhode Island Hospital Discharge Data (HDD) from 2000 to 2004 was used. International Classification of Disease (ICD-9) diagnosis code 042-044 was used to identify HIV/AIDS admissions. The final study population included 1927 HIV/AIDS discharges. We used a multivariable linear regression model to examine the factors associated with inflation adjusted inpatient charges. RESULTS We found a significant increase in inpatient charges from 2000-2004 after adjusting for length of stay (LOS), gender, age, race and point of entry for hospitalization. In addition to calendar year, LOS, gender and race were also associated with inpatient charges. CONCLUSION HIV/AIDS inpatient charges increased after adjusting for inflation despite earlier studies that showed a decline. Our results have implications for uninsured, as well as insured HIV/AIDS patients who do not have a medical plan that covers their charges sufficiently. Future research should investigate what factors are contributing to rising inpatient charges among HIV/AIDS patients.
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Affiliation(s)
- Kamil E Barbour
- Brown University Program in Public Health, Center for Population Health and Clinical Epidemiology, 121 South Main Street, Providence, RI 02912, USA
- University of Pittsburgh, Center for Aging and Population Health, 130 N Bellefield Avenue, Pittsburgh, PA, 15213, USA
| | - Anthony Fabio
- University of Pittsburgh, Center for Injury Research and Control, 3471 5th Ave # 810, Pittsburgh, PA 15213, USA
| | - Deborah N Pearlman
- Brown University Program in Public Health, Center for Population Health and Clinical Epidemiology, 121 South Main Street, Providence, RI 02912, USA
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Im EO, Chee W, Lim HJ, Liu WM. An online forum exploring needs for help of patients with cancer: gender and ethnic differences. Oncol Nurs Forum 2008; 35:653-60. [PMID: 18591169 DOI: 10.1188/08.onf.653-660] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To explore gender and ethnic differences in needs for help among patients with cancer. RESEARCH APPROACH Qualitative. SETTING Internet and community settings. PARTICIPANTS 16 self-identified patients with cancer aged at least 18 years who could read and write English. METHODOLOGIC APPROACH Using six discussion topics on needs for help, an online forum was administered for one month. Data were analyzed with thematic analysis. MAIN RESEARCH VARIABLES Need for help. FINDINGS Four major themes emerged: (a) from side effects to racism, (b) same or double stress, (c) cultural hesitance and God, and (d) a family disease with mistrust. Depending on gender and ethnicity, the participants' concerns were various and ranged from a simple physical need to a social need for elimination of racism in United States society. Women tended to report double burden and stress as patients with cancer resulting from their gender. Ethnic minorities tended to be hesitant to talk about cancer or seek help because of the stigmatized nature of cancer. Ethnic minority patients perceived cancer as a family disease that they needed to go through as a family, and they tended to mistrust healthcare providers. CONCLUSIONS The overriding theme was a marginalized experience for ethnic minority patients with cancer. INTERPRETATION Researchers should include cultural needs as a separate category of needs and consider contextual factors influencing the needs of patients with cancer in their daily lives.
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Affiliation(s)
- Eun-Ok Im
- School of Nursing, University of Texas, Austin, TX, USA.
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Prognostic implications of emergency admission and delays in patients with breast cancer. Support Care Cancer 2008; 17:595-9. [PMID: 18841396 DOI: 10.1007/s00520-008-0513-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/18/2008] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study evaluates clinical-pathological characteristics and survival rates associated with emergency admission and delays in diagnosis and treatment of 411 consecutive breast cancer patients. MATERIALS AND METHODS Emergency admission and first symptom-first hospital visit delay were significantly associated with advanced tumor stages but only in the former case with short disease-free survival (RR 2.5, CI 95% 1.5-4.2). RESULTS Brief diagnostic delays were significantly associated with advanced disease stage and poor survival rates (RR 2.04; CI 95% 1.08-3.82) probably because sicker patients receive prompt medical attention.
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Shack L, Jordan C, Thomson CS, Mak V, Møller H. Variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England. BMC Cancer 2008; 8:271. [PMID: 18822122 PMCID: PMC2577116 DOI: 10.1186/1471-2407-8-271] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 09/26/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer incidence varies by socioeconomic group and these variations have been linked with environmental and lifestyle factors, differences in access to health care and health seeking behaviour. Socioeconomic variations in cancer incidence by region and age are less clearly understood but they are crucial for targeting prevention measures and health care commissioning. METHODS Data were obtained from all eight English cancer registries for patients diagnosed between 1998 and 2003, for all invasive cases of female breast cancer (ICD-10 code C50), lung cancer (ICD-10 codes C33-C34), cervical cancer (ICD-10 code C53), and malignant melanoma of the skin (ICD-10 code C43). Socioeconomic status was assigned to each patient based on their postcode of residence at diagnosis, using the income domain of the Index of Multiple Deprivation 2004. We analysed the socioeconomic variations in the incidence of breast, lung and cervical cancer and malignant melanoma of the skin for England, and regionally and by age. RESULTS Incidence was highest for the most deprived patients for lung cancer and cervical cancer, whilst the opposite was observed for malignant melanoma and breast cancer. The difference in incidence between the most and the least deprived groups was higher for lung cancer patients aged under 65 at diagnosis than those over 65 at diagnosis, which may indicate a cohort effect. There were regional differences in the socioeconomic gradients with the gap being widest for lung and cervical cancer in the North (North East, North West and Yorkshire and Humberside) and for malignant melanoma in the East and South West. There were only modest variations in breast cancer incidence by region. If the incidence of lung and cervical cancer were decreased to that of the least deprived group it would prevent 36% of lung cancer cases in men, 38% of lung cancer cases in women and 28% of cervical cancer cases. Incidence of breast cancer and melanoma was highest in the least deprived group, therefore if all socioeconomic groups had incidence rates similar to the least deprived group it is estimated that the number of cases would increase by 7% for breast cancer, 27% for melanoma in men and 29% for melanoma in women. CONCLUSION National comparison of socioeconomic variations in cancer incidence by region and age can provide an unbiased basis for public health prevention and health commissioning. Decreasing inequalities in incidence requires the integration of information on risk factors, incidence and projected incidence but targeted public health interventions could help to reduce regional inequalities in incidence and reduce the future cancer burden.
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Affiliation(s)
- Lorraine Shack
- North West Cancer Intelligence Service, Christie Hospital NHS Trust, Kinnaird Road, Withington, Manchester, M20 4QL, UK.
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Mitry E, Rachet B, Quinn MJ, Cooper N, Coleman MP. Survival from cancer of the colon in England and Wales up to 2001. Br J Cancer 2008; 99 Suppl 1:S26-9. [PMID: 18813251 PMCID: PMC2557549 DOI: 10.1038/sj.bjc.6604578] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- E Mitry
- Département d'Hépatogastroentérologie et Oncologie Digestive, Centre Hospitalo-Universitaire Ambroise-Paré, 9 avenue Charles de Gaulle, Boulogne F-92100, France
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Zbar AP, Inniss M, Prussia PR, Shenoy R. The changing distribution of colorectal cancer in Barbados: 1985-2004. Dis Colon Rectum 2007; 50:1215-22. [PMID: 17566831 DOI: 10.1007/s10350-007-0238-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Recent reports have suggested a shift to the right in older female patients of colon cancer. This is believed to be representative of more accessible national endoscopic screening programs. METHODS We report the demographic shift in colorectal cancer based on an analysis of resection specimens during four five-year time periods from 1985 to 2004 at the University Hospital, Barbados. Differences in population-based colorectal cancer incidence, age, gender, site, stage, and presentation (emergency vs. elective) are analyzed. RESULTS A total of 1,014 specimens obtained from 993 patients were analyzed, showing a progressive population-based increase in colorectal cancer in Barbados during this 20-year time period. There was an increase in right-sided tumors (P < 0.0001) without a concomitant decline in left-sided tumors. There was a significant increase in Dukes A cancers (P < 0.0001) without gender predilection. During the time period, there was a significant reduction in right-sided tumors presenting as emergencies (P < 0.005) without an effect of stage or gender. CONCLUSIONS There has been a steady increase in both right-sided and left-sided colonic cancers without gender predilection. The increase in early-stage tumors and reduction in emergency presentations during the latter part of the study suggests value in instituting a formal national colonoscopic screening program to assess its prospective effect on these parameters.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery, School of Clinical Medicine and Research, The University of the West Indies, Queen Elizabeth Hospital Barbados, St Michael, Barbados.
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Bottle A, Aylin P, Majeed A. Identifying patients at high risk of emergency hospital admissions: a logistic regression analysis. J R Soc Med 2006. [PMID: 16893941 DOI: 10.1258/jrsm.99.8.406] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To use routine data to identify patients at high risk of future emergency hospital admissions. DESIGN Descriptive analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression. SETTING National Health Service hospital trusts in England. PARTICIPANTS All patients with an emergency admission to an NHS hospital between 1 April 2000 and 31 March 2001. MAIN OUTCOME MEASURES 'High-impact users' were defined as patients who had at least one emergency inpatient admission and who then went on to have at least two further emergency hospital admissions in the 12 months following the start date of that index admission. RESULTS 2,895,234 patients were admitted as emergencies in 2000/2001, of whom 147,725 (5.1%) did not survive their first spell. Of the 2,747,509 surviving patients, 269,686 (9.8%) subsequently had at least two or more emergency admissions within 365 days of the index date of admission. A further 236,779 (8.6%) died during this period. Risk factors for becoming a high-impact user included the number of emergencies in the 36 months before index spell, comorbidity, age, an admission for an ambulatory care sensitive condition, ethnicity, area-level socioeconomic data, local admission rates, the number of episodes in the index spell, sex and the source of admission. The predictive model based on all emergency admissions produced a receiver operating characteristic curve score of 0.72. CONCLUSIONS Routine hospital episode statistics can be used to identify patients who are at high risk of suffering future multiple emergency hospital admissions. The potential cost savings in preventing a proportion of these subsequent admissions need to be compared with the costs of case management of these patients.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Social Medicine, Imperial College London, London W6 8RP, UK.
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Abstract
BACKGROUND Geographical inequalities in lung cancer treatment and patient survival have been described. We hypothesized that lung cancer patients' access to treatment may be influenced by deprivation and the pathway to care. METHODS Case notes were reviewed for patients resident in south-east London who were registered with lung cancer at the Thames Cancer Registry in 1998. Use of surgery, chemotherapy, radiotherapy or any specific treatment and one-year survival were examined. Analyses were adjusted for age, sex, histology, stage and basis of diagnosis. RESULTS Data for 695 out of 958 (73%) patients were analysed. Subjects who were initially referred to a specialist in thoracic medicine, surgery or oncology were more likely to receive active treatment (71%) than subjects who were referred to other consultants (51%) or who were admitted as emergencies (42%) (P < 0.0001). CONCLUSION Socio-economic deprivation was associated with lower rates of treatment and this partly explained variations in survival. Subjects who were referred to specialists were more likely to receive active treatment and treatment patterns varied between first trust attended.
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Affiliation(s)
- Ruth H Jack
- King's College London, Department of Public Health Services, London, UK.
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Pearce MS, Deary IJ, Young AH, Parker L. Childhood IQ and deaths up to middle age: The Newcastle Thousand Families Study. Public Health 2006; 120:1020-6. [PMID: 16935314 DOI: 10.1016/j.puhe.2006.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Revised: 05/08/2006] [Accepted: 06/28/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To test the hypothesis that an association exists between childhood IQ (at age 11) and mortality up to middle age. STUDY DESIGN The Newcastle Thousand Families study, a prospectively followed cohort, originally consisted of all 1142 births in the city of Newcastle in May and June 1947. Using data on 717 members of this cohort, we investigated the associations between the results of tests of IQ and English and arithmetic ability at age 11 years and mortality up to the end of 2003 using Cox's proportional hazards models. RESULTS Childhood IQ was significantly related to mortality in men (hazard ratio 0.57 for a standard deviation change in IQ at age 11; 95% CI 0.37, 0.86; P=0.007), but not in women (hazard ratio 0.79; 95% CI 0.49, 1.27; P=0.33). Adjustment for social class at birth had little effect on the associations. Similar results were seen when using the English and arithmetic scores. CONCLUSIONS These results confirm a recently reported association between individual differences in childhood cognition and mortality up to middle age, independent of childhood socio-economic circumstances. It is possible that the link between IQ and mortality is in part mediated through later life choices. Further research is required to identify the mechanisms by which such an association may occur, and to provide input to health promotion and disease management strategies that may improve health throughout life.
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Affiliation(s)
- M S Pearce
- Paediatric and Lifecourse Epidemiology Research Group, School of Clinical Medical Sciences, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
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Bouchardy C, Verkooijen HM, Fioretta G. Social class is an important and independent prognostic factor of breast cancer mortality. Int J Cancer 2006; 119:1145-51. [PMID: 16557599 DOI: 10.1002/ijc.21889] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Reasons of the important impact of socioeconomic status on breast cancer prognosis are far from established. This study aims to evaluate and explain the social disparities in breast cancer survival in the Swiss canton of Geneva, where healthcare costs and life expectancy are among the highest in the world. This population-based study included all 3,920 female residents of Geneva, who were diagnosed with invasive breast cancer before the age of 70 years between 1980 and 2000. Patients were divided into 4 socioeconomic groups, according to the woman's last occupation. We used Cox multivariate regression analysis to identify reasons for the socioeconomic inequalities in breast cancer survival. Compared to patients of high social class, those of low social class had an increased risk (unadjusted hazard ratio [HR] 2.4, 95% CI: 1.6-3.5) of dying as a result of breast cancer. These women were more often foreigners, less frequently had screen-detected cancer and were at more advanced stage at diagnosis. They less frequently underwent breast-conserving surgery, hormonal therapy, and chemotherapy, in particular, in case of axillary lymph node involvement. When adjusting for all these factors, patients of low social class still had a significantly increased risk of dying of breast cancer (HR 1.8, 95% CI: 1.2-2.6). Overmortality linked to low SES is only partly explained by delayed diagnosis, unfavorable tumor characteristics and suboptimal treatments. Other factors, not measured in this study, also could play a role. While waiting for the outcome of other researches, we should consider socioeconomic status as an independent prognostic factor and provide intensified support and surveillance to women of low social class.
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Affiliation(s)
- Christine Bouchardy
- Geneva Cancer Registry, Institute for Social and Preventive Medicine, University of Geneva, Switzerland.
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Bottle A, Aylin P, Majeed A. Identifying patients at high risk of emergency hospital admissions: a logistic regression analysis. J R Soc Med 2006; 99:406-14. [PMID: 16893941 PMCID: PMC1533524 DOI: 10.1177/014107680609900818] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To use routine data to identify patients at high risk of future emergency hospital admissions. DESIGN Descriptive analysis of inpatient hospital episode statistics. Predictive model developed using multiple logistic regression. SETTING National Health Service hospital trusts in England. PARTICIPANTS All patients with an emergency admission to an NHS hospital between 1 April 2000 and 31 March 2001. MAIN OUTCOME MEASURES 'High-impact users' were defined as patients who had at least one emergency inpatient admission and who then went on to have at least two further emergency hospital admissions in the 12 months following the start date of that index admission. RESULTS 2,895,234 patients were admitted as emergencies in 2000/2001, of whom 147,725 (5.1%) did not survive their first spell. Of the 2,747,509 surviving patients, 269,686 (9.8%) subsequently had at least two or more emergency admissions within 365 days of the index date of admission. A further 236,779 (8.6%) died during this period. Risk factors for becoming a high-impact user included the number of emergencies in the 36 months before index spell, comorbidity, age, an admission for an ambulatory care sensitive condition, ethnicity, area-level socioeconomic data, local admission rates, the number of episodes in the index spell, sex and the source of admission. The predictive model based on all emergency admissions produced a receiver operating characteristic curve score of 0.72. CONCLUSIONS Routine hospital episode statistics can be used to identify patients who are at high risk of suffering future multiple emergency hospital admissions. The potential cost savings in preventing a proportion of these subsequent admissions need to be compared with the costs of case management of these patients.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Social Medicine, Imperial College London, London W6 8RP, UK.
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Smith JJ, Tilney HS, Heriot AG, Darzi AW, Forbes H, Thompson MR, Stamatakis JD, Tekkis PP. Social deprivation and outcomes in colorectal cancer. Br J Surg 2006; 93:1123-31. [PMID: 16779877 DOI: 10.1002/bjs.5357] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
The aim of this study was to examine the influence of social deprivation on postoperative mortality and length of stay in patients having surgery for colorectal cancer.
Methods
Data were extracted from the Association of Coloproctology of Great Britain and Ireland database of patients presenting between April 2001 and March 2002. The effect of social deprivation, measured by the Townsend score, on 30-day postoperative mortality and length of stay was evaluated by two-level hierarchical regression analysis.
Results
A total of 7290 (86·8 per cent) patients underwent surgery. Operative mortality was 6·7 per cent and median length of stay 11 days. Deprivation indices were significantly higher in patients with Dukes' ‘D’ cancers, undergoing emergency surgery and with higher American Society of Anesthesiologists (ASA) grades (P < 0·005). Worsening deprivation was associated with higher operative mortality and longer stay (P = 0·014). For each unit increase in deprivation, there was 2·9 (95 per cent confidence interval 0·5 to 5·2) per cent increase in 30-day mortality. On multifactorial analysis, social deprivation was an independent predictor of length of stay, but its effect on operative mortality was explained by differences in ASA grade, operative urgency and Dukes' classification.
Conclusion
Social deprivation was an independent risk factor of postoperative length of stay and associated with higher postoperative mortality. These results have important implications for risk modelling of postoperative outcomes.
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Affiliation(s)
- J J Smith
- Department of Surgery, West Middlesex Hospital, Isleworth, and Department of Biosurgery and Surgical Technology, Imperial College London, UK
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Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol 2006; 101:1098-103. [PMID: 16573783 DOI: 10.1111/j.1572-0241.2006.00488.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Previous studies have shown that patients newly diagnosed with colorectal cancer (CRC) requiring emergency admission to hospital or those presenting with obstruction or perforation (defined here as OPE) have advanced disease. The objective was to conduct a population-based study among persons with a new diagnosis of CRC to identify factors associated with OPE in Ontario. METHODS We analyzed data from the following databases: Canadian Institute for Health Information (CIHI), the Ontario Health Insurance Plan (OHIP), and the Registered Persons Database (RPDB). We identified all individuals > or = 20 yr of age with a new diagnosis of CRC (ICD-9 codes 153.0-153.4, 153.6-154.1) during 1996-2001 and defined the first admission for CRC as the index admission. We excluded those who received chemotherapy, radiotherapy, or palliative care prior to the index admission. We identified those with concomitant obstruction (ICD-9 code 560.9), perforation (ICD-9 code 569.8), or who were classified as emergency admission (referred to as OPE). Adjusted risk of OPE was calculated using logistic regression analysis. RESULTS Between 1996 and 2001, we identified 41,356 persons with CRC, of whom 53.5% were men. In logistic regression analysis, female sex and low income were significantly associated with OPE, after adjusting for differences in age, cancer site, previous large bowel evaluation, comorbidity, having a regular source of primary care, and year of diagnosis. For men the adjusted odds ratio (OR) for OPE was 0.93 (95% confidence interval (CI) 0.88-0.99), and for the highest-income quintile the adjusted OR was 0.78 (95% CI 0.72-0.85). CONCLUSION Among persons with a new diagnosis of CRC in Ontario, women and those who are poor are more likely to present with obstruction, perforation, or emergency admission to hospital. Population-based CRC screening is needed to address these adverse outcomes.
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Affiliation(s)
- Linda Rabeneck
- Institute for Clinical Evaluative Sciences, University of Toronto, Ontario, Canada
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Abstract
It is well established that socio-economic status is a major prognostic factor for many cancers, including colorectal cancer. The aims of this review are (i) to report epidemiological data showing how socio-economic status influences colorectal cancer survival, (ii) to attempt to describe the mechanisms underlying these survival inequalities, and (iii) to assess their impact on survival of colorectal cancer.
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Affiliation(s)
- Emmanuel Mitry
- Service d'Hépato-Gastroentérologie et Oncologie Digestive, CHU Ambroise Paré, AP-HP et UFR de Médecine Paris- Ile de France Ouest, Boulogne.
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Saxena S, George J, Barber J, Fitzpatrick J, Majeed A. Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: cross sectional analysis. J R Soc Med 2006. [PMID: 16449782 DOI: 10.1258/jrsm.99.2.81] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To examine the association between underlying ill health, material deprivation and primary care supply factors and hospital admission rates for potentially avoidable admissions in primary care trusts in London. DESIGN Cross sectional analysis at primary care trusts level using routine data from multiple sources. SETTING All 31 primary care trusts in London with a total resident population of 7 million patients. MAIN OUTCOME MEASURES Age-standardized hospital admission rates for asthma, diabetes, heart failure, hypertension and chronic obstructive pulmonary disease. RESULTS Admission rates varied widely for the conditions examined across the 31 primary care trusts. In 2001, age adjusted admission rates for asthma varied from 76 to 189 per 100,000 and for diabetes from 38 to 183 per 100,000. There was a significant association between higher admission rates and measures of underlying ill health and material deprivation but not quantitative measures of primary care service provision. Provision of specialist chronic disease services in primary care for diabetes but not for asthma were significantly associated with reduced admission rates. There was no association of prescribing levels in primary care trusts with admission rates for any of the conditions examined. CONCLUSIONS Although hospital admission for some chronic diseases is potentially avoidable and rates of hospital admission for these conditions are possible indicators of the quality of care, they should be interpreted in conjunction with measures of population composition and deprivation. Failure to do this may result in primary care trusts and general practitioners being criticized for aspects of health care utilization that are not under their direct control.
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Affiliation(s)
- Sonia Saxena
- Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London W6 8RP.
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Woods LM, Rachet B, Coleman MP. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006; 17:5-19. [PMID: 16143594 DOI: 10.1093/annonc/mdj007] [Citation(s) in RCA: 478] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer survival is known to vary by socio-economic group. A review of studies published by 1995 showed this association to be universal and resilient to the many different ways in which socio-economic status was determined. Differences were most commonly attributed to differences in stage of disease at diagnosis. MATERIALS AND METHODS A review of research published since 1995 examining the association of cancer survival with socio-economic variables. RESULTS An association between socio-economic status and cancer survival has continued to be demonstrated in the last decade of research. Stage at diagnosis and differences in treatment have been cited as the most important explanatory factors. Some research has evaluated the psychosocial elements of this association. CONCLUSIONS Socio-economic differences in cancer survival are now well documented. The explanatory power of stage at diagnosis, although great, should not detract from the evidence of differential treatment between social groups. Neither factor can completely explain the observed socio-economic differences in survival, however, and the importance of differences in tumour and patient factors should now be quantified.
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Affiliation(s)
- L M Woods
- Non-Communicable Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, London, UK.
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