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Title: Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
Author: Manchon Walsh, Paula
Aliste, Luisa
Borràs Andrés, Josep Maria
Coll Ortega, Cristina
Casacuberta, Joan
Casanovas Guitart, Cristina
Clèries, Montse
Cruz, Sergi
Guarga, Àlex
Mompart, Anna
Planella, Antoni
Pozuelo, Alfonso
Ticó, Isabel
Vela, Emili
Prades, Joan
Keywords: Càncer de pàncrees
Càncer colorectal
Salut pública
Drets socials i econòmics
Pancreas cancer
Colorectal cancer
Public health
Social and economic rights
Issue Date: 20-Jul-2022
Publisher: MDPI AG
Abstract: The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.
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It is part of: International Journal of Environmental Research and Public Health, 2022, vol. 19, num. 14, p. 8814
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ISSN: 1660-4601
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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