Disparities in time to breast cancer surgery in New Zealand by level of neighbourhood deprivation: a population-based study.

PURPOSE

The New Zealand (NZ) Faster Cancer Treatment (FCT) plan aims for equitable cancer treatment irrespective of sociodemographic factors. Research on its impact on breast cancer surgery times is limited. This study evaluates whether (1) there are differences by level of neighbourhood deprivation in time to surgery in women with early-stage (1-3a) breast cancer in NZ between 2000 and 2020 and (2) whether this association differs pre- and post- FCT implementation.

METHODS

This retrospective analysis used Te Rēhita Mate Ūtaetae (NZ Breast Cancer Foundation National Register), a prospectively maintained national database of breast cancers. Logistic regression models evaluated differences by neighbourhood deprivation in time to surgery beyond 31 days (defined in the FCT as the longest acceptable delay in time to first treatment). Deprivation was measured using the NZ Deprivation (NZDep) Index, an area-based measure of socioeconomic deprivation in deciles (decile 1 = least deprived to decile 10 = most deprived) categorised into quintiles. Models were adjusted sequentially for potential contributing factors across five domains; demographic [age, ethnicity, urban or rural place of residence], mode of diagnosis [screening programme or symptomatic], tumour [stage, grade, receptors], treatment facility type [public/private hospital] and treatment [locoregional and systemic]. Subgroup analysis by pre- and post-FCT implementation date were undertaken.

RESULTS

Of the 20,322 women included in the analysis, 23.5% were in the least deprived neighborhoods (NZDep index 1-2) and 13.8% were in the most deprived neighborhoods (NZDep index 9-10) and 22.3% 21.0% 19.5% were in 3-4, 5-6 and 7-8, respectively. Overall, 73% of the women were NZ European, 10% Māori (indigenous NZ people), 7% Pacific (from the Pacific islands) and 10% were Asian. In the unadjusted model, compared to the least deprived quintile, all other NZDep index quintiles were more likely to experience delay beyond 31 days. In the maximally adjusted model, compared to the least deprived quintile, only women in the most deprived quintile were more likely to experience delay in time to surgery > 31 days (OR 1.31; 95% CI: 1.17, 1.47). Key contributing factors to this reduction in OR were ethnicity and treatment facility type. A marginal but non-significant reduction in time to surgery was observed in the post-FCT period.

CONCLUSION

Women residing in more deprived neighborhoods experienced greater delay in time to breast cancer surgery. Despite FCT implementation, urgent action is still needed to reduce inequities by deprivation in timely access to breast cancer surgery.