School of Social Work, University of Windsor, Windsor, Ontario, Canada.
Am J Public Health. 2011 Jan;101(1):112-9. doi: 10.2105/AJPH.2009.173112. Epub 2010 Mar 18.
We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California.
We analyzed registry data for colon cancer patients from Ontario (n = 930) and California (n = 1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses.
Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle- to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco.
Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.
我们考察了在加拿大安大略省多伦多市和美国加利福尼亚州旧金山,社会经济地位对结肠癌治疗和生存的差异影响。
我们分析了来自安大略省(n=930)和加利福尼亚州(n=1014)的结肠癌患者的登记数据,这些患者的诊断时间为 1996 年至 2000 年,随访至 2006 年,观察其分期、手术、辅助化疗和生存情况。我们从人口普查中获取了个人住所的社会经济数据。
在旧金山,收入与淋巴结评估、化疗和生存直接相关,但在多伦多并非如此。高收入人群在旧金山的生存率高于多伦多。在调整分期后,多伦多低收入居民的生存率高于旧金山。中低收入患者在多伦多接受指示性化疗的可能性高于旧金山。
社会经济因素似乎在美国城市地区调节结肠癌的治疗,但在加拿大并非如此。需要改善美国低收入人群的筛查、诊断调查和治疗机会。