Murage Peninah, Crawford S Michael, Bachmann Max, Jones Andy
Norwich Medical School, University of East Anglia, UK.
Airedale NHS Foundation Trust, UK.
Health Place. 2016 Nov;42:11-18. doi: 10.1016/j.healthplace.2016.08.014. Epub 2016 Sep 8.
This study seeks to examine the extent to which cancer services are geographically located according to cancer incidence, and assess the association with cancer survival. We identified hospital sites serving English PCTs (Primary Care Trusts) with the management and treatment of breast, lung and colorectal cancer. Geographical access was estimated as travel time in minutes from LSOAs (Lower Super Output Areas) to the nearest hospital site and aggregated to PCT level. Correlations between PCT level mean travel times and cancer cases were estimated using Spearman's rank correlation. Associations between PCT level mean travel times and cancer relative survival rates were estimated using linear regression with adjustment for area deprivation and for a PCT level measure of the reported ease of obtaining a doctor's appointment. We found that cancer services tended to be located farther from areas with more cancer cases, and longer average travel times are associated with worse survival after adjustment for age, sex, year and area deprivation. This suggests that geographical access to cancer services remains a concern in England.
本研究旨在探讨癌症服务在地理位置上根据癌症发病率分布的程度，并评估其与癌症生存率的关联。我们确定了为英格兰初级保健信托基金（PCTs）提供乳腺癌、肺癌和结直肠癌管理与治疗服务的医院地点。地理可达性以从低级超级输出区（LSOAs）到最近医院地点的出行时间（分钟）来估计，并汇总到PCT层面。使用斯皮尔曼等级相关来估计PCT层面平均出行时间与癌症病例之间的相关性。使用线性回归估计PCT层面平均出行时间与癌症相对生存率之间的关联，并对地区贫困程度以及PCT层面报告的预约看医生的难易程度进行调整。我们发现，癌症服务往往位于离癌症病例较多的地区更远的地方，并且在对年龄、性别、年份和地区贫困程度进行调整后，平均出行时间越长与生存率越低相关。这表明在英格兰，获得癌症服务的地理可达性仍然是一个问题。
