Does Socioeconomic Status Affect Stage at Presentation for Larynx Cancer in Canada's Universal Health Care System?

Abstract

Objective: Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita).

Study design: Registry-based multicenter cohort analysis.

Setting: This was a national study across Canada, a country with a single-payer, universal health care system.

Subjects: All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR).

Methods: Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation.

Results: A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005).

Conclusion: There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system.

Keywords: age at diagnosis; income; laryngeal cancer; rural residence; socioeconomic status; stage at diagnosis; urban residence.