Cancer and Chronic Conditions (C3) Research Group, Department of Public Health, University of Otago, Wellington, New Zealand.
University of Waikato, Hamilton, New Zealand.
PLoS One. 2022 Aug 11;17(8):e0269593. doi: 10.1371/journal.pone.0269593. eCollection 2022.
In New Zealand, there are known disparities between the Indigenous Māori and the majority non-Indigenous European populations in access to cancer treatment, with resulting disparities in cancer survival. There is international evidence of ethnic disparities in the distance travelled to access cancer treatment; and as such, the aim of this paper was to examine the distance and time travelled to access surgical care between Māori and European liver and stomach cancer patients. We used national-level data and Geographic Information Systems (GIS) analysis to describe the distance travelled by patients to receive their first primary surgery for liver or stomach cancer, as well as the estimated time to travel this distance by road, and the surgical volume of hospitals performing these procedures. All cases of liver (ICD-10-AM 3rd edition code: C22) and stomach (C16) cancer that occurred in New Zealand (2007-2019) were drawn from the New Zealand Cancer Registry (liver cancer: 866 Māori, 2,460 European; stomach cancer: 953 Māori, 3,192 European), and linked to national inpatient hospitalisation records to examine access to surgery. We found that Māori on average travel 120km for liver cancer surgery, compared to around 60km for Europeans, while a substantial minority of both Māori and European liver cancer patients must travel more than 200km for their first primary liver surgery, and this situation appears worse for Māori (36% vs 29%; adj. OR 1.48, 95% CI 1.09-2.01). No such disparities were observed for stomach cancer. This contrast between cancers is likely driven by the centralisation of liver cancer surgery relative to stomach cancer. In order to support Māori to access liver cancer care, we recommend that additional support is provided to Māori patients (including prospective financial support), and that efforts are made to remotely provide those clinical services that can be decentralised.
在新西兰，土著毛利人和多数非毛利欧洲人在获得癌症治疗方面存在已知的差异，这导致了癌症存活率的差异。有国际证据表明，在获得癌症治疗的距离方面存在种族差异；因此，本文的目的是检查毛利人和欧洲肝癌和胃癌患者接受手术治疗的距离和时间。我们使用国家级数据和地理信息系统（GIS）分析来描述患者接受首次原发性肝癌或胃癌手术的旅行距离，以及通过公路旅行这段距离的估计时间，以及进行这些手术的医院的手术量。从新西兰癌症登记处（肝癌：ICD-10-AM 第 3 版代码：C22；866 名毛利人，2460 名欧洲人；胃癌：953 名毛利人，3192 名欧洲人）抽取了新西兰发生的所有肝癌（C16）和胃癌病例（2007-2019 年），并与国家住院记录相关联，以检查手术的可及性。我们发现，毛利人平均要为肝癌手术旅行 120 公里，而欧洲人则为 60 公里左右，而相当一部分毛利人和欧洲肝癌患者必须为他们的第一次原发性肝癌手术旅行超过 200 公里，而且这种情况对毛利人来说更糟（36%比 29%；调整后的 OR 1.48，95%CI 1.09-2.01）。对于胃癌，没有观察到这种差异。这种癌症之间的差异可能是由肝癌手术相对于胃癌的集中化驱动的。为了支持毛利人获得肝癌护理，我们建议为毛利人患者提供额外的支持（包括前瞻性财务支持），并努力远程提供可以分散的那些临床服务。
