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Comparative Study
. 2020 Oct 14;15(10):e0240444.
doi: 10.1371/journal.pone.0240444. eCollection 2020.

Cancer resection rates, socioeconomic deprivation, and geographical access to surgery among urban, suburban, and rural populations across Canada

Blake Byron Walker  1 , Nadine Schuurman  2 , Chuck K Wen  3 , Saad Shakeel  3 , Laura Schneider  4 , Christian Finley  4
Affiliations
Comparative Study

Cancer resection rates, socioeconomic deprivation, and geographical access to surgery among urban, suburban, and rural populations across Canada

Blake Byron Walker et al. PLoS One. .

Abstract

High-risk cancer resection surgeries are increasingly being performed at fewer, more specialised, and higher-volume institutions across Canada. The resulting increase in travel time for patients to obtain treatment may be exacerbated by socioeconomic barriers to access. Focussing on five high-risk surgery types (oesophageal, ovarian/fallopian, liver, lung, and pancreatic cancers), this study examines socioeconomic trends in age-adjusted resection rates and travel time to surgery location for urban, suburban, and rural populations across Canada, excluding Québec, from 2004 to 2012. Significant differences in age-adjusted resection rates were observed between urban (14.9 per 100 000 person-years [95% CI: 12.2, 17.6]), suburban (40.7 [40.1, 41.2]), and rural (32.7 [29.6, 35.9]) populations, with higher rates in suburban and rural areas throughout the study period for all cancer types. Resection rates did not differ between the highest (Q1) and lowest (Q5) socioeconomic strata (Q1: 13.3 [12.2, 14.4]; Q5: 12.0 [10.7, 13.4]), with significantly higher rates among middle-SES patients (Q2: 27.3 [25.6, 29.0]; Q3: 39.6 [37.4, 41.8]; Q4: 37.5 [35.3, 39.7]). Travel times to treatment were consistently higher among the most socioeconomically deprived patients, most notably in suburban and rural areas. The results suggest that the conventional inclusion of suburbs with urban areas in health research may obfuscate important trends for public health policy and programmes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Age- and sex-adjusted resection rates by tumour site and socioeconomic deprivation quintile, in 3-year intervals from 2004–2012.
Fig 2
Fig 2. Age- and sex-adjusted resection rates for five cancer types, by neighbourhood type, in three-year intervals from 2004–2012.
Fig 3
Fig 3. Age- and sex-adjusted resection rates per 100 000 person-years, with 95% CI, by neighbourhood type and socioeconomic deprivation quintile (Q5 = patients among the 20% most deprived adults in the Canadian population).
Fig 4
Fig 4. Mean patient travel time from resection surgery location.
See this image and copyright information in PMC

References

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