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Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)

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 ca...

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Autores principales: Manchon-Walsh, Paula, Aliste, Luisa, Borràs, Josep M., 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9322195/
https://www.ncbi.nlm.nih.gov/pubmed/35886665
http://dx.doi.org/10.3390/ijerph19148814
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author Manchon-Walsh, Paula
Aliste, Luisa
Borràs, Josep M.
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
author_facet Manchon-Walsh, Paula
Aliste, Luisa
Borràs, Josep M.
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
author_sort Manchon-Walsh, Paula
collection PubMed
description 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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spelling pubmed-93221952022-07-27 Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain) Manchon-Walsh, Paula Aliste, Luisa Borràs, Josep M. 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 Int J Environ Res Public Health Article 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. MDPI 2022-07-20 /pmc/articles/PMC9322195/ /pubmed/35886665 http://dx.doi.org/10.3390/ijerph19148814 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Manchon-Walsh, Paula
Aliste, Luisa
Borràs, Josep M.
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
Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
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)
title_full Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
title_fullStr Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
title_full_unstemmed Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
title_short Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain)
title_sort socioeconomic status and distance to reference centers for complex cancer diseases: a source of health inequalities? a population cohort study based on catalonia (spain)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9322195/
https://www.ncbi.nlm.nih.gov/pubmed/35886665
http://dx.doi.org/10.3390/ijerph19148814
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