SOCIOECONOMIC DISPARITIES IN ACCESS TO TREATMENT AND THEIR IMPACT ON COLORECTAL CANCER SURVIVAL
Résumé
Background: Significant socioeconomic disparities have been reported in survival from colorectal cancer in a number of countries, which remain largely unexplained. We assessed whether possible differences in access to treatment among socioeconomic groups may contribute to those disparities, using a population-based approach. Methods: We retrospectively studied 71,917 records of colorectal cancer patients, diagnosed between 1997 and 2000, linked to area-level socioeconomic information (Townsend index), from three cancer registries in England. Access to treatment was measured as a function of delay in receipt of treatment. We assessed socioeconomic differences in access through logistic regression models. Based on relative survival up to three years after diagnosis, we estimated excess hazard ratios of death (EHR) for different socioeconomic groups. Results: Compared to more affluent patients, deprived patients had poorer survival (EHR=1.20; 95%CI [1.16-1.25]), were less likely to receive any treatment within six months (OR=0.87, 95%CI 0.82-0.92) and if treated, were more likely to receive late treatment. No disparities in survival were detected among patients receiving treatment within one month from diagnosis. Disparities existed among patients receiving later or no treatment (EHR=1.30; 95%CI [1.22-1.39]), and persisted after adjustment for age and stage at diagnosis (EHR=1.15; 95%CI [1.08-1.24]). Conclusions: Tumour stage helped explain socioeconomic disparities in colorectal cancer survival. Disparities were also greatly attenuated among patients receiving early treatment. Aspects other than those captured by our measure of access, such as quality of care and patient preferences in relation to treatment, might contribute to a fuller explanation.
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