Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway.
BMC Health Serv Res. 2021 Nov 25;21(1):1272. doi: 10.1186/s12913-021-07250-1.
In 2015, cancer patient pathways (CPP) were implemented in Norway to reduce unnecessary non-medical delay in the diagnostic process and start of treatment. The main aim of this study was to investigate the equality in access to CPPs for patients with either lung, colorectal, breast or prostate cancer in Norway.
National population-based data on individual level from 2015 to 2017 were used to study two proportions; i) patients in CPPs without the cancer diagnosis, and ii) cancer patients included in CPPs. Logistic regression was applied to examine the associations between these proportions and place of residence (hospital referral area), age, education, income, comorbidity and travel time to hospital.
Age and place of residence were the two most important factors for describing the variation in proportions. For the CPP patients, inconsistent differences were found for income and education, while for the cancer patients the probability of being included in a CPP increased with income.
The age effect can be related to both the increasing risk of cancer and increasing number of GP and hospital contacts with age. The non-systematic results for CPP patients according to income and education can be interpreted as equitable access, as opposed to the systematic differences found among cancer patients in different income groups. The inequalities between income groups among cancer patients and the inequalities based on the patients' place of residence, for both CPP and cancer patients, are unwarranted and need to be addressed.
2015 年，挪威实施了癌症患者路径（CPP），以减少诊断过程和治疗开始时不必要的非医疗延误。本研究的主要目的是调查挪威肺癌、结直肠癌、乳腺癌或前列腺癌患者获得 CPP 的平等情况。
使用 2015 年至 2017 年的全国基于人群的个体水平数据，研究两个比例：i）未确诊癌症的 CPP 患者，ii）纳入 CPP 的癌症患者。应用逻辑回归检验这些比例与居住地（医院转诊区）、年龄、教育、收入、合并症和到医院的旅行时间之间的关联。
年龄和居住地是描述比例变化的两个最重要因素。对于 CPP 患者，收入和教育的差异不一致，而对于癌症患者，纳入 CPP 的概率随收入增加而增加。
年龄效应可能与癌症风险的增加以及与年龄相关的全科医生和医院接触次数的增加有关。根据收入和教育，CPP 患者的结果没有系统性差异，可以解释为平等获得，而不同收入组的癌症患者则存在系统差异。癌症患者的收入群体之间的不平等以及 CPP 和癌症患者的居住地之间的不平等都是不合理的，需要解决。
