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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. |
Note: | Reproducció del document publicat a: https://doi.org/10.3390/ijerph19148814 |
It is part of: | International Journal of Environmental Research and Public Health, 2022, vol. 19, num. 14, p. 8814 |
URI: | http://hdl.handle.net/2445/188893 |
Related resource: | https://doi.org/10.3390/ijerph19148814 |
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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ijerph-19-08814.pdf | 2.21 MB | Adobe PDF | View/Open |
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