Institut für Geographie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Dept. of Geography, Simon Fraser University, Burnaby, British Columbia, Canada.
PLoS One. 2020 Oct 14;15(10):e0240444. doi: 10.1371/journal.pone.0240444. eCollection 2020.
High-risk cancer resection surgeries are increasingly being performed at fewer, more specialised, and higher-volume institutions across Canada. The resulting increase in travel time for patients to obtain treatment may be exacerbated by socioeconomic barriers to access. Focussing on five high-risk surgery types (oesophageal, ovarian/fallopian, liver, lung, and pancreatic cancers), this study examines socioeconomic trends in age-adjusted resection rates and travel time to surgery location for urban, suburban, and rural populations across Canada, excluding Québec, from 2004 to 2012. Significant differences in age-adjusted resection rates were observed between urban (14.9 per 100 000 person-years [95% CI: 12.2, 17.6]), suburban (40.7 [40.1, 41.2]), and rural (32.7 [29.6, 35.9]) populations, with higher rates in suburban and rural areas throughout the study period for all cancer types. Resection rates did not differ between the highest (Q1) and lowest (Q5) socioeconomic strata (Q1: 13.3 [12.2, 14.4]; Q5: 12.0 [10.7, 13.4]), with significantly higher rates among middle-SES patients (Q2: 27.3 [25.6, 29.0]; Q3: 39.6 [37.4, 41.8]; Q4: 37.5 [35.3, 39.7]). Travel times to treatment were consistently higher among the most socioeconomically deprived patients, most notably in suburban and rural areas. The results suggest that the conventional inclusion of suburbs with urban areas in health research may obfuscate important trends for public health policy and programmes.
高风险癌症切除术越来越多地在加拿大少数几家更加专业和大容量的机构中进行。由于获得治疗的社会经济障碍，患者前往治疗地点的旅行时间可能会增加。本研究重点关注五种高风险手术类型（食管癌、卵巢/输卵管癌、肝癌、肺癌和胰腺癌），研究了 2004 年至 2012 年期间，加拿大（魁北克除外）城市、郊区和农村地区的人口年龄调整后切除术率和手术地点旅行时间的社会经济趋势。城市（14.9/100000 人年[95%CI：12.2，17.6]）、郊区（40.7[40.1，41.2]）和农村（32.7[29.6，35.9]）人群的年龄调整后切除术率存在显著差异，在整个研究期间，所有癌症类型的郊区和农村地区的比率均较高。在最高（Q1）和最低（Q5）社会经济阶层（Q1：13.3[12.2，14.4]；Q5：12.0[10.7，13.4]）之间，切除术率没有差异，而中 SES 患者的比率显著更高（Q2：27.3[25.6，29.0]；Q3：39.6[37.4，41.8]；Q4：37.5[35.3，39.7]）。在最贫困的社会经济患者中，前往治疗的旅行时间始终较高，在郊区和农村地区尤为明显。研究结果表明，在健康研究中传统上将郊区与城市地区合并可能会掩盖公共卫生政策和计划的重要趋势。
