Residence, income and cancer hospitalizations in British Columbia during a decade of policy change
Tóm tắt
Through the 1990s, governments across Canada shifted health care funding allocation and organizational foci toward a community-based population health model. Major concerns of reform based on this model include ensuring equitable access to health and health care, and enhancing preventive and community-based resources for care. Reforms may act differentially relative to specific conditions and services, including those geared to chronic versus acute conditions. The present study therefore focuses on health service utilization, specifically cancer hospitalizations, in British Columbia during a decade of health system reform. Data were drawn from the British Columbia Linked Health Data resource; income measures were derived from Statistics Canada 1996 Census public use enumeration area income files. Records with a discharge (separation) date between 1 January 1991 and 31 December 1998 were selected. All hospitalizations with ICD-9 codes 140 through 208 (except skin cancer, code 173) as principal diagnosis were included. Specific cancers analyzed include lung; colorectal; female breast; and prostate. Hospitalizations were examined in total (all separations), and as divided into first and all other hospitalizations attributed to any given individual. Annual trends in age-sex adjusted rates were analyzed by joinpoint regression; longitudinal multivariate analyses assessing association of residence and income with hospitalizations utilized generalised estimating equations. Results are evaluated in relation to cancer incidence trends, health policy reform and access to care. Age-sex adjusted hospitalization rates for all separations for all cancers, and lung, breast and prostate cancers, decreased significantly over the study period; colorectal cancer separations did not change significantly. Rates for first and other hospitalizations remained stationary or gradually declined over the study period. Area of residence and income were not significantly associated with first hospitalizations; effects were less consistent for all and other hospitalizations. No interactions were observed for any category of separations. No discontinuities were observed with respect to total hospitalizations that could be associated temporally with health policy reform; observed changes were primarily gradual. These results do not indicate whether equity was present prior to health care reform. However, findings concur with previous reports indicating no change in access to health care across income or residence consequent on health care reform.
Tài liệu tham khảo
British Columbia: Closer to Home. Report of the Royal Commission on Health Care and Costs. 1991, Victoria, British Columbia
British Columbia: New Directions for a Healthy British Columbia. 1993, Victoria, British Columbia: Ministry of Health and Ministry Responsible for Seniors
McPhail JK: Better team work, better care: The new approach to regionalization. 1996, Victoria, British Columbia
Evans RG, Barer ML, Marmor TR, editors: Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. 1994, New York: Aldine de Gruyter
Wilkinson RG: Unhealthy Societies. The Afflictions of Inequality. 1996, London: Routledge
Young TK: Population Health. Concepts and Methods. 1998, New York: Oxford University Press
Dunn JR, Hayes MV: Toward a lexicon of population health. Can J Public Health. 1999, 90 (Suppl 1): S7-S10.
Health Canada: Population Health Approach. Website viewed 25 June 2003, [http://www.hc-sc.gc.ca/hppb/phdd/approach/index.html]
Dunn JR, Hayes MV: Social inequality, population health and housing: a study of two Vancouver neighbourhoods. Soc Sci Med. 2000, 51: 563-587. 10.1016/S0277-9536(99)00496-7.
Brownell MD, Roos NP, Roos L: Monitoring health reform: a report card approach. Soc Sci Med. 2001, 52: 657-670. 10.1016/S0277-9536(00)00168-4.
Hertzman C, Frank J, Evans RG: Heterogeneities in health status and the determinants of population health. In Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. Edited by: Evans RG, Barer ML, Marmor TR. 1994, New York: Aldine de Gruyter, 67-92.
House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR: The social stratification of aging and health. J Health Soc Behav. 1994, 35: 213-234.
Carriere KC, Roos LL, Dover DC: Across time and space: variations in hospital use during Canadian health reform. Health Serv Res. 2000, 35: 467-487.
Liu L, Hader J, Brossart B, White R, Lewis S: Impact of rural hospital closures in Saskatchewan, Canada. Soc Sci Med. 2001, 52: 1793-1804. 10.1016/S0277-9536(00)00298-7.
Shortt SE, Shaw RA, : Equity in Canadian health care: Does socio-economic status affect waiting times for elective surgery?. CMAJ. 2003, 168: 413-416.
Canadian Institute for Health Information: Hospitalizations by leading diagnoses and gender, Canada 2001/02. Website viewed 25 May 2004, [http://secure.cihi.ca/cihiweb/en/media_19nov2003_tab5_e.html]
Pisani P, Bray F, Parkin DM: Estimates of the world-wide prevalence of cancer for 25 sites in the adult population. Int J Cancer. 2002, 97: 72-81. 10.1002/ijc.1571.
Gorey KM, Vena JE: The association of near poverty status with cancer incidence among black and white adults. J Community Health. 1995, 20: 359-366.
Gorey KM, Holowaty EJ, Laukkanen E, Fehringer G, Richter NL: Association between socioeconomic status and cancer incidence in Toronto, Ontario: possible confounding of cancer mortality by incidence and survival. Cancer Prev Control. 1998, 2: 236-241.
Mao Y, Hu J, Ugnat AM, Semenciw R, Fincham S, The Canadian Cancer Registries Epidemiology Research Group: Socio-economic status and lung cancer risk in Canada. Int J Epidemiol. 2001, 30: 809-817. 10.1093/ije/30.4.809.
Mackillop WJ, Zhang-Salomons J, Boyd CJ, Groome PA: Associations between community income and cancer incidence in Canada and the United States. Cancer. 2000, 89: 901-912. 10.1002/1097-0142(20000815)89:4<901::AID-CNCR25>3.0.CO;2-I.
Bradley CJ, Given CW, Roberts C: Disparities in cancer diagnosis and survival. Cancer. 2001, 91: 178-188. 10.1002/1097-0142(20010101)91:1<178::AID-CNCR23>3.0.CO;2-S.
Bradley CJ, Given CW, Roberts C: Race, socio-economic status, and breast cancer treatment and survival. J Natl Cancer Inst. 2002, 94: 490-496. 10.1093/jnci/94.7.490.
Mackillop WJ, Zhang-Salomons J, Groome PA, Paszat L, Holowaty E: Socio-economic status and cancer survival in Ontario. J Clin Oncol. 1997, 15: 1680-1689.
Boyd C, Zhang-Salomons JY, Groome PA, Mackillop WJ: Associations between community income and cancer survival in Ontario, Canada, and the United States. J Clin Oncol. 1999, 17: 2244-2455.
Thomson CS, Hole DJ, Twelves CJ, Brewster DH, Black RJ, Scottish Cancer Therapy Network: Prognostic factors in women with breast cancer: distribution by socio-economic status and effect on differences in survival. J Epidemiol Community Health. 2001, 55: 308-315. 10.1136/jech.55.5.308.
Desoubeaux N, Herbert C, Launoy G, Maurel J, Gignoux M: Social environment and prognosis of colorectal cancer patients: a French population-based study. Int J Cancer. 1997, 73: 317-322. 10.1002/(SICI)1097-0215(19971104)73:3<317::AID-IJC2>3.3.CO;2-D.
Kravdal O: Social inequalities in cancer survival. Population Studies. 2000, 54: 1-18.
Schrijvers CT, Coebergh JW, Mackenbach JP: Socio-economic status and comorbidity among newly diagnosed cancer patients. Cancer. 1997, 80: 1482-1488. 10.1002/(SICI)1097-0142(19971015)80:8<1482::AID-CNCR16>3.3.CO;2-F.
Brewster DH, Thomson CS, Hole DJ, Black RJ, Stroner PL, Gillis CR: Relation between socioeconomic status and tumour stage in patients with breast, colorectal, ovarian, and lung cancer: results from four national, population based studies. BMJ. 2001, 322: 830-831. 10.1136/bmj.322.7290.830.
Farrow DC, Samet JM, Hunt WC: Regional variation in survival following the diagnosis of cancer. J Clin Epidemiol. 1996, 49: 843-847. 10.1016/0895-4356(96)00176-X.
Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J: Rural and urban differences in stage at diagnosis of colorectal and lung cancers. Br J Cancer. 2001, 84: 910-914. 10.1054/bjoc.2000.1708.
Goodwin JS, Freeman JL, Mahnken JD, Freeman DH, Nattinger AB: Geographic variations in breast cancer survival among older women: implications for quality of breast cancer care. J Gerontol A Biol Sci Med Sci. 2002, 57: M401-M406.
Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J: Impact of deprivation and rural residence on treatment of colorectal and lung cancer. Br J Cancer. 2002, 87: 585-590. 10.1038/sj.bjc.6600515.
Paszat LF, Mackillop WJ, Groome PA, Zhang-Salomons J, Schulze K, Holowaty E: Radiotherapy for breast cancer in Ontario: rate variation associated with region, age and income. Clin Invest Med. 1998, 21: 125-134.
Gorey KM, Holowary EJ, Fehringer G, Laukkanen E, Moskowitz A, Webster DJ, Richter NL: An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas. Am J Public Health. 1997, 87: 1156-1163.
Gorey KM, Holowaty EJ, Laukkanen E, Fehringer G, Richter NL: An international comparison of cancer survival: advantage of Toronto's poor over the near poor of Detroit. Can J Public Health. 1998, 89: 102-104.
Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Richter NL, Meyer CM: An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii. Am J Public Health. 2000, 90: 1866-1872.
Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Richter NL, Meyer CM: An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas. J Public Health Med. 2000, 22: 343-348. 10.1093/pubmed/22.3.343.
Gorey KM, Kliewer E, Holowaty EJ, Laukkanen E, Ng EY: An international comparison of breast cancer survival: Winnipeg, Manitoba and Des Moines, Iowa, metropolitan areas. Ann Epidemiol. 2003, 13: 32-41. 10.1016/S1047-2797(02)00259-4.
Gilson L: Discussion: In defense and pursuit of equity. Soc Sci Med. 1998, 47: 1891-1896. 10.1016/S0277-9536(98)00217-2.
Chamberlayne R, Green B, Barer ML, Hertzman C, Lawrence WJ, Sheps SB: Creating a population-based linked health database: a new resource for health services research. Can J Public Health. 1998, 89: 270-273.
National Cancer Institute of Canada: Canadian Cancer Statistics 2002. Toronto, Canada. 2002
Sin DD, Svenson LW, Man SFP: Do area-based markers of poverty accurately measure personal poverty?. Can J Public Health. 2001, 92: 184-187.
SAS Institute Inc: SAS Statistical Analysis System version 8.00. 1998, Cary, North Carolina, USA
Burchill C, Nicol P, Wadia A, Bogdanovic B, MacWilliam L, Travers D, Carriere KC, Tate B, Horrocks J: Standardized Rates Macro v 6.34 2000/11/19. 2000, Manitoba Centre for Health Policy and Evaluation. Winnipeg, Manitoba
British Columbia Ministry of Finance and Corporate Relations: BC STATS Population Estimates and Projections (PEOPLE 24). 1999, Victoria, British Columbia
Kim HJ, Fay MP, Feuer EJ, Midthune DN: Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000, 19: 335-351. 10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.3.CO;2-Q. (correction to article in Stat Med 2001; 20:655)., [http://srab.cancer.gov/joinpoint/]
Allison PD: Logistic Regression Using the SAS System: Theory and Application. 1999, New York: BBU Press and John Wiley Sons Inc
Hanley JA, Negassa A, Edwardes MD, Forrester JE: Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol. 2003, 157: 364-375. 10.1093/aje/kwf215.
British Columbia Cancer Agency: Trends, Numbers and Rates in All Cancers – Incidence. Website visited 25 June 2003, [http://www.bccancer.bc.ca/HPI/CancerStatistics/Trends/Rates/start.htm]
Breen N, Figueroa JB: Stage of breast and cervical cancer diagnosis in disadvantaged neighborhoods: a prevention policy perspective. Am J Prev Med. 1996, 12: 319-326.
Merkin SS, Stevenson L, Powe N: Geographic socio-economic status, race, and advanced-stage breast cancer in New York City. Am J Public Health. 2002, 92: 64-70.
Singh GK, Miller BA, Hankey BF, Edwards BK: Area Socioeconomic Variations in U.S. Cancer Incidence, Mortality, Stage, Treatment, and Survival, 1975–1999. 2003, NCI Cancer Surveillance Monograph Series, Number 4. Bethesda, MD: National Cancer Institute. NIH Publication No. 03-5417
British Columbia Ministry of Health Planning: A new for patient-centred health care. 2001, Victoria, British Columbia, Website visited 25 June 2003, [http://www.healthservices.gov.bc.ca/socsec/pdf/new_era_sustain.pdf]