Matias Maria Ana, Santos Rita, Siciliani Luigi, Sivey Peter, Proctor Andrew
Centre for Health Economics, University of York, York, UK.
Department of Economics and Related Studies, University of York, York, UK.
Health Econ. 2025 Feb;34(2):203-224. doi: 10.1002/hec.4906. Epub 2024 Oct 3.
Prompt access to cancer care is a policy priority in several OECD countries, because delayed access can exacerbate deleterious health outcomes. Access to care based on need remains a key pillar of publicly-funded health systems. This study tests for the presence of inequalities in waiting times by socioeconomic status for patients receiving breast cancer surgery (mastectomy or breast conserving surgery) in England using the Hospital Episode Statistics. We investigate separately the pre-COVID-19 period (April 2015-January 2020), and the COVID-19 period (February 2020-March 2022). We use linear regression models to study the association between waiting times and income deprivation measured at the patient's area of residence. We control for demographic factors, type and number of comorbidities, past emergency admissions and Healthcare Resource Groups, and supply-level factors through hospital fixed effects. In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient's area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7 days (given a mean waiting time of 20.6 days).
在经合组织的几个国家，迅速获得癌症治疗是一项政策重点，因为延迟获得治疗会加剧有害的健康后果。基于需求获得治疗仍然是公共资助卫生系统的一个关键支柱。本研究利用医院病历统计数据，对英格兰接受乳腺癌手术（乳房切除术或保乳手术）的患者按社会经济地位划分的候诊时间不平等情况进行了检验。我们分别调查了新冠疫情前时期（2015年4月至2020年1月）和新冠疫情时期（2020年2月至2022年3月）。我们使用线性回归模型来研究候诊时间与患者居住地区收入贫困程度之间的关联。我们控制了人口因素、合并症的类型和数量、过去的急诊入院情况以及医疗资源分组，并通过医院固定效应控制了供应层面的因素。在新冠疫情前时期，我们没有发现患者居住地区的收入贫困程度与手术候诊时间之间存在统计学上的显著关联。在新冠疫情时期，我们发现生活在最贫困地区的患者候诊时间延长了0.7天（平均候诊时间为20.6天）。
