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Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study

OBJECTIVES: When combined, liver and stomach cancers are second only to lung cancer as the most common causes of cancer death for the indigenous Māori population of New Zealand—with Māori also experiencing substantial disparities in the likelihood of survival once diagnosed with these cancers. Since...

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Autores principales: Gurney, Jason, Sarfati, Diana, Stanley, James, Kerrison, Clarence, Koea, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058766/
https://www.ncbi.nlm.nih.gov/pubmed/35487720
http://dx.doi.org/10.1136/bmjopen-2021-058749
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author Gurney, Jason
Sarfati, Diana
Stanley, James
Kerrison, Clarence
Koea, Jonathan
author_facet Gurney, Jason
Sarfati, Diana
Stanley, James
Kerrison, Clarence
Koea, Jonathan
author_sort Gurney, Jason
collection PubMed
description OBJECTIVES: When combined, liver and stomach cancers are second only to lung cancer as the most common causes of cancer death for the indigenous Māori population of New Zealand—with Māori also experiencing substantial disparities in the likelihood of survival once diagnosed with these cancers. Since a key driver of this disparity in survival could be access to surgical treatment, we have used national-level data to examine surgical procedures performed on Māori patients with liver and stomach cancers and compared the likelihood and timing of access with the majority European population. DESIGN, PARTICIPANTS AND SETTING: We examined all cases of liver and stomach cancers diagnosed during 2007–2019 on the New Zealand Cancer Registry (liver cancer: 866 Māori, 2460 European; stomach cancer: 953 Māori, 3192 European) and linked these cases to all inpatient hospitalisations that occurred over this time to identify curative and palliative surgical procedures. As well as descriptive analysis, we compared the likelihood of access to a given procedure between Māori and Europeans, stratified by cancer and adjusted for confounding and mediating factors. Finally, we compared the timing of access to a given procedure between ethnic groups. RESULTS AND CONCLUSIONS: We found that (a) access to liver transplant for Māori is lower than for Europeans; (b) Māori with stomach cancer appear more likely to require the type of palliation consistent with gastric outlet obstruction; and (c) differential timing of first stomach cancer surgery between Māori and European patients. However, we may also be cautiously encouraged by the fact that differences in overall access to curative surgical treatment were either marginal (liver) or absent (stomach).
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spelling pubmed-90587662022-05-12 Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study Gurney, Jason Sarfati, Diana Stanley, James Kerrison, Clarence Koea, Jonathan BMJ Open Oncology OBJECTIVES: When combined, liver and stomach cancers are second only to lung cancer as the most common causes of cancer death for the indigenous Māori population of New Zealand—with Māori also experiencing substantial disparities in the likelihood of survival once diagnosed with these cancers. Since a key driver of this disparity in survival could be access to surgical treatment, we have used national-level data to examine surgical procedures performed on Māori patients with liver and stomach cancers and compared the likelihood and timing of access with the majority European population. DESIGN, PARTICIPANTS AND SETTING: We examined all cases of liver and stomach cancers diagnosed during 2007–2019 on the New Zealand Cancer Registry (liver cancer: 866 Māori, 2460 European; stomach cancer: 953 Māori, 3192 European) and linked these cases to all inpatient hospitalisations that occurred over this time to identify curative and palliative surgical procedures. As well as descriptive analysis, we compared the likelihood of access to a given procedure between Māori and Europeans, stratified by cancer and adjusted for confounding and mediating factors. Finally, we compared the timing of access to a given procedure between ethnic groups. RESULTS AND CONCLUSIONS: We found that (a) access to liver transplant for Māori is lower than for Europeans; (b) Māori with stomach cancer appear more likely to require the type of palliation consistent with gastric outlet obstruction; and (c) differential timing of first stomach cancer surgery between Māori and European patients. However, we may also be cautiously encouraged by the fact that differences in overall access to curative surgical treatment were either marginal (liver) or absent (stomach). BMJ Publishing Group 2022-04-29 /pmc/articles/PMC9058766/ /pubmed/35487720 http://dx.doi.org/10.1136/bmjopen-2021-058749 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Oncology
Gurney, Jason
Sarfati, Diana
Stanley, James
Kerrison, Clarence
Koea, Jonathan
Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title_full Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title_fullStr Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title_full_unstemmed Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title_short Equity of timely access to liver and stomach cancer surgery for Indigenous patients in New Zealand: a national cohort study
title_sort equity of timely access to liver and stomach cancer surgery for indigenous patients in new zealand: a national cohort study
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058766/
https://www.ncbi.nlm.nih.gov/pubmed/35487720
http://dx.doi.org/10.1136/bmjopen-2021-058749
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