Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Bunkyo-ku, Tokyo, Japan.
Cancer Med. 2024 Jul;13(14):e70042. doi: 10.1002/cam4.70042.
A methodology for determining the appropriate balance between medical access and combating poverty remains undetermined. To address the boundary conditions for exceedingly good medical access, this study examined whether the impact of deprivation on cancer stage distribution could be eliminated in Japan, which has the highest hospital bed density in the world.
A nationwide medical claims-based database was used to evaluate the influence of municipality-level hospital bed density and the postal code-level areal deprivation index on cancer stage at diagnosis. Given the limited number of similar studies in Japan, we focused on colorectal cancer (CRC), for which disparities have been reported in a prefecture-level study. Multilevel multivariate logistic regression models were used, with odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for baseline and socioeconomic factors.
Regardless of the early/advanced-stage definitions, CRC consistently tended to be detected at more advanced stages in more deprived areas. In the analysis of stages 0-I/II-IV, the OR (95% CI) was 1.09 (1.05, 1.14) (p < 0.001). In the analyses of stages 0-I/II-IV and 0-II/III-IV, gradients were observed, and later detections were observed for more deprived segments. Hospital bed density was not significantly associated with the stage distribution.
The results indicate that inequalities in CRC detection due to deprivation persist even in the country with the highest hospital bed density worldwide, suggesting that poverty measures remain indispensable regardless of hospital bed access. Further investigation of various regions and cancers is required to develop a practical framework.
确定在医疗可及性和扶贫之间取得适当平衡的方法仍未确定。为了解决极好的医疗可及性的边界条件问题，本研究考察了在世界上拥有最高医院床位密度的日本，贫困对癌症分期分布的影响是否可以消除。
利用全国性的医疗索赔数据库，评估市级医院床位密度和邮政编码级区域剥夺指数对诊断时癌症分期的影响。鉴于日本类似研究的数量有限，我们专注于结直肠癌（CRC），因为在一个县一级的研究中已经报道了 CRC 存在差异。使用多水平多变量逻辑回归模型，调整了基线和社会经济因素后的比值比（OR）和 95%置信区间（CI）。
无论早期/晚期阶段的定义如何，CRC 在贫困地区的检出率始终较高，处于较晚期阶段。在 0-I/II-IV 期的分析中，OR（95%CI）为 1.09（1.05，1.14）（p<0.001）。在 0-I/II-IV 期和 0-II/III-IV 期的分析中，观察到了梯度，贫困地区的检出时间较晚。医院床位密度与分期分布无显著相关性。
研究结果表明，即使在全球拥有最高医院床位密度的国家，由于贫困导致的 CRC 检出不平等现象仍然存在，这表明无论医院床位的可及性如何，贫困措施仍然不可或缺。需要进一步调查各个地区和癌症，以制定实用框架。
