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. 2022 Jul 20;19(14):8814.
doi: 10.3390/ijerph19148814.

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

Paula Manchon-Walsh  1   2 , Luisa Aliste  1   2 , Josep M Borràs  1   2 , Cristina Coll-Ortega  1 , Joan Casacuberta  3 , Cristina Casanovas-Guitart  4 , Montse Clèries  5   6 , Sergi Cruz  7 , Àlex Guarga  4 , Anna Mompart  7 , Antoni Planella  7 , Alfonso Pozuelo  4 , Isabel Ticó  3 , Emili Vela  5   6 , Joan Prades  1   2
Affiliations

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

Paula Manchon-Walsh et al. Int J Environ Res Public Health. .

Abstract

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.

Keywords: centralization; geographical distance; health care access; health equity; quality of cancer care; reference centre; socioeconomic status.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Distribution of pancreatic cancer cases according to locations of patients’ homes and surgical centers in Catalonia. (a) All cases of pancreatic cancer (N = 646). (b) Selection of cases with the longest distances (>90th%) between the patients’ homes and the reference centers (N = 64). Each color represents a different reference center.
Figure 3
Figure 3
Distribution of rectal cancer cases according to locations of patients’ homes and surgical centers in Catalonia. (a) All cases of rectal cancer (N = 1455). (b) Selection of cases with the longest distances (>90th%) between the patients’ homes and the reference centers (N = 142). Each color represents a different reference center.
Figure 4
Figure 4
Survival by (a) stage and (b) socioeconomic status in pancreatic cancer patients.
Figure 5
Figure 5
Survival by (a) stage and (b) socioeconomic status in rectal cancer patients.
See this image and copyright information in PMC

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