Cancer resection rates, socioeconomic deprivation, and geographical access to surgery among urban, suburban, and rural populations across Canada

Abstract

High-risk cancer resection surgeries are increasingly being performed at fewer, more specialised, and higher-volume institutions across Canada. The resulting increase in travel time for patients to obtain treatment may be exacerbated by socioeconomic barriers to access. Focussing on five high-risk surgery types (oesophageal, ovarian/fallopian, liver, lung, and pancreatic cancers), this study examines socioeconomic trends in age-adjusted resection rates and travel time to surgery location for urban, suburban, and rural populations across Canada, excluding Qué bec, from 2004 to 2012. Significant differences in age-adjusted resection rates were observed between urban (14.9 per 100 000 person-years [95% CI: 12.2, 17.6]), suburban (40.7 [40.1, 41.2]), and rural (32.7 [29.6, 35.9]) populations, with higher rates in suburban and rural areas throughout the study period for all cancer types. Resection rates did not differ between the highest (Q1) and lowest (Q5) socioeconomic strata (Q1: 13.

General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey

“…Further studies are needed to understand the difference in satisfaction between country villages and country homes, the latter being the area with the lowest level of satisfaction in our multivariable model (Table 2), regardless of the other factors considered. The difference in level of satisfaction may be related to inadequate quality, quantity or distribution of primary care providers [19,43,[58][59][60]; to a greater difficulty in accessing local or tertiary hospitals [61,62]; or to a voluntary reduced use of health care services [42,60,63]. Rural villagers' satisfaction may also be related to the supportive role of small communities [60,61] that may be absent in people who live more isolated.…”

A narrative review: has regionalization truly achieved its intended goal in the surgical management of pancreatic cancer?

“…The barriers to regionalized pancreas cancer in western health systems are significant and reflect the interplay of many conflicting and nuanced factors and processes. Most fundamentally, countries without single-payor health care systems or flexible insurance coverage policies face significant barriers to adopting regionalized cancer care models (18)(19)(20)(21)(22). Without fundamental change to the relationship between patient, hospital system, and health insurance coverage, regionalized cancer care will remain unfeasible (18)(19)(20)(21)(22).…”

“…Since the initial promotion of minimum-volume standards in pancreas cancer surgery, many have argued that regionalized care would only worsen already existing disparities in access to pancreas cancer treatment. Regionalization does not solve and actually may worsen existing disparities in access to pancreas cancer care faced by patients disadvantaged by rurality, race, or socioeconomic status (18)(19)(20)(21)(22). Instead, regionalization may offer further benefits to patients who are most advantaged in western health care systems-those who are white, wealthy, and urban (18)(19)(20)(21)(22).…”

“…Regionalization does not solve and actually may worsen existing disparities in access to pancreas cancer care faced by patients disadvantaged by rurality, race, or socioeconomic status (18)(19)(20)(21)(22). Instead, regionalization may offer further benefits to patients who are most advantaged in western health care systems-those who are white, wealthy, and urban (18)(19)(20)(21)(22).…”

Neighborhood Greenspace and Socioeconomic Risk are Associated with Diabetes Risk at the Sub-neighborhood Scale: Results from the Prospective Urban and Rural Epidemiology (PURE) Study

“…At the neighborhood scale, these measures represent the socioeconomic composition of an area and have been used to identify policy interventions targeting the socioeconomic component of disease risk. In public health planning and prevention programmes, area-based SES indices (e.g., the Vancouver Area Neighborhood Deprivation Index) have demonstrated immense value as correlates for a wide range of diseases, syndromes, and health conditions [ 7 ]. Even when controlling for individual- or household-level SES, area-based metrics often remain significant predictors, suggesting a social-environmental/neighborhood-scale compositional component to the effects of SES on health [ 5 , 8 , 9 ].…”