Tazi M A, Roy P, Liabeuf A, Faivre J
Registre Bourguignon des Tumeurs Digestives (Equipe associée INSERM-DGS), Faculté de Médecine de Dijon.
Gastroenterol Clin Biol. 1995 Jun-Jul;19(6-7):604-12.
The goal of this study was to analyze the characteristics of colorectal cancer patients associated with the distribution of the incident cases in the health care pattern (public, private and mixed health care options) and to study the development of this distribution over time.
The study concerned 3,403 cases of colorectal cancer diagnosed in the Côte-d'Or region, France between 1976 and 1990. The relationship between patient characteristics and the type of health care pattern was analyzed using a polychotomous logistic regression model.
Data analysis indicates an uneven patient distribution among the public (40.6%), private (47.3%) and mixed (12.1%) sectors. The proportion of patients received in the public sector increased with the age of the patient with a proportional decrease in private and mixed sectors: compared with patients under 65 years cared for in the public sector, the odds ratio characteristic of the private sector was 0.74 for the age group 65-74 and 0.44 for those over 74 years. The odds ratios characteristic of the mixed sector were 0.71 and 0.41 respectively. Cases demonstrating symptoms received care more often in the private sector (48.3%) than in the public (38.7%) or mixed (13%) sectors, whereas those diagnosed in patients with no digestive disorders as well as those diagnosed in emergency situations were mainly cared for in the public sector. Cancers in advanced stages were more often treated in the public sector. In the case of palliative treatment, the patients were more often treated in the public sector than in the private sector or mixed sector. This phenomenon was more marked in the case of symptomatic treatments: with curative treatment taken as the category of reference, the odds ratios associated with symptomatic treatment were 0.38 for the private sector and 0.18 for the mixed sector. Over the period of time examined, there was an increase in the proportion of patients receiving care in the private sector when they lived in the area serviced by Dijon or in areas without a health "structure". Patients residing in areas with a general hospital unchanged over time. Relatively disadvantaged social categories were more often associated with care in the public sector.
This study shows that the characteristics of colorectal cancer patients differ between the public and private sectors. It shows the differences in recruitment of health care structures according to the treatment of those patients. The study provides information useful in conceiving regional schemes of health care organisation.
本研究的目的是分析与医疗模式（公立、私立和混合医疗选择）中结直肠癌患者发病病例分布相关的特征，并研究这种分布随时间的变化情况。
该研究涉及1976年至1990年间在法国科多尔地区诊断出的3403例结直肠癌病例。使用多分类逻辑回归模型分析患者特征与医疗模式类型之间的关系。
数据分析表明患者在公立部门（40.6%）、私立部门（47.3%）和混合部门（12.1%）之间的分布不均衡。公立部门接收的患者比例随着患者年龄的增加而增加，私立和混合部门的比例相应下降：与65岁以下在公立部门接受治疗的患者相比，65 - 74岁年龄组私立部门的优势比为0.74，74岁以上为0.44。混合部门的优势比分别为0.71和0.41。有症状的病例在私立部门接受治疗的比例更高（48.3%），高于公立部门（38.7%）和混合部门（13%），而那些在无消化系统疾病患者中诊断出的病例以及在急诊情况下诊断出的病例主要在公立部门接受治疗。晚期癌症在公立部门接受治疗的情况更为常见。在姑息治疗方面，患者在公立部门接受治疗的情况比在私立部门或混合部门更为常见。这种现象在对症治疗中更为明显：以根治性治疗作为参照类别，私立部门对症治疗的优势比为0.38，混合部门为0.18。在研究期间，居住在第戎服务区域或无医疗“机构”地区的患者在私立部门接受治疗的比例有所增加。居住在有综合医院地区的患者比例随时间没有变化。相对弱势的社会阶层更常与公立部门的治疗相关。
本研究表明结直肠癌患者在公立和私立部门的特征存在差异。它显示了根据患者治疗情况在医疗机构招募方面的差异。该研究为构思区域医疗组织方案提供了有用信息。
