Pagano Eva, Di Cuonzo Daniela, Bona Cristina, Baldi Ileana, Gabriele Pietro, Ricardi Umberto, Rotta Paolo, Bertetto Oscar, Appiano Silvana, Merletti Franco, Segnan Nereo, Ciccone Giovannino
Unit of Cancer Epidemiology, Ospedale S. Giovanni Battista, CPO-Piemonte, University of Turin, Italy.
Health Policy. 2007 Mar;80(3):483-91. doi: 10.1016/j.healthpol.2006.05.006. Epub 2006 Jun 14.
A survey was conducted of radiotherapy (RT) resources and utilization in a northwestern Italian Region in order to assess geographical variations in radiotherapy utilization rates, and the effects of infrastructure supply on accessibility.
The survey was conducted by analysing standardized utilization rates based on administrative records. The data were analysed at both Regional and Local Health Unit (LHU) level.
Wide variation was found among LHUs RT utilization rates--the sex- and age-standardized rates varied from 1.8/1000 inhabitants to more than 3/1000 inhabitants. Patients resident in LHUs with no RT service showed a lower probability of accessing RT (standardized rate ratio (SRR), 0.82; 95%IC, 0.80-0.85). The utilization rate decreased in relation to the distance between a patient's residence and the nearest RT service; the reduction was greater for patients > or =70 years of age.
The wide geographic variation implies lack of equity in access to services. Utilization levels decreased significantly with increasing distance from the nearest RT service, distance being a barrier to access particularly for older persons. The heterogeneous distribution of services on the Regional territory seems a relevant explanation of differences in utilization rates.
对意大利西北部一个地区的放射治疗（RT）资源及利用情况进行了调查，以评估放射治疗利用率的地理差异，以及基础设施供应对可及性的影响。
通过分析基于行政记录的标准化利用率来开展此次调查。数据在地区和地方卫生单位（LHU）层面进行了分析。
发现各地方卫生单位的放射治疗利用率差异很大——性别和年龄标准化率从每千居民1.8例到超过每千居民3例不等。居住在没有放射治疗服务的地方卫生单位的患者接受放射治疗的可能性较低（标准化率比（SRR），0.82；95%置信区间，0.80 - 0.85）。利用率随着患者居住地与最近的放射治疗服务机构之间的距离增加而降低；70岁及以上患者的降幅更大。
广泛的地理差异意味着服务可及性方面缺乏公平性。随着与最近的放射治疗服务机构距离的增加，利用率显著下降，距离是获取服务的一个障碍，对老年人尤其如此。该地区服务的不均匀分布似乎是利用率差异的一个重要解释。
