Health inequities and cancer survival in Manizales, Colombia: a population-based study

Abstract

Objective: To analyze differences in survival of breast, cervical, lung, prostate and stomach cancer by health insurance regime (HIR) and socioeconomic position (SEP) in an intermediate city in a middle-income country.Methods: All patients with breast, cervix uteri, lung, prostate and stomach cancer diagnosed between 2003 and 2007 and characterized by the Manizales population-based Cancer Registry (MCR) were included and followed up to a maximum of 5 years for identifying deaths. Survival probabilities estimated by HIR were defined according to the type of affiliation at the date of diagnosis, and by socioeconomic stratification of residence (SS) as indicator of SEP, stratifying for other prognostic factors using Kaplan-Meier methods. Cox proportional hazard models were fitted for multivariate analysis.Results: A total of 1,384 cases and 700 deaths were analyzed. Five-year observed survival was 71.0% (95% IC: 66.1-75.3) for breast, 51.4% (95% IC: 44.6-57.9) for cervix, 15.4% (95% IC: 10.7-20.8) for lung, 71.1% (95% IC: 65.3-76.1) for prostate and 23.8% (95% IC: 19.3-28.6) for stomach. Statistically significant differences in survival by HIR were observed for breast, lung, prostate, and stomach - with poorer survival for the subsidized and uninsured patients. Differences by SS were observed for lung and prostate. Differences in survival by HIR were independent of SS, and viceversa. Conclusions: Important inequities in cancer survival exist related to HIR and SEP. Possible explanations include underlying comorbidities, late stage at diagnosis, or barriers to timely and effective treatment.

Incidencia y mortalidad por cáncer en Medellín, Colombia. 2010-2014

“…Table 2 shows the comparison of the ASIR for all cancer localizations in Medellin with four other Colombian registries situated in Cali 32 , Bucaramanga 33 , Manizales 34 and Pasto 35 . The average annual ASR was 144 per 100,000 men and 145 per 100,000 women during 2010-2014.…”

“…La Tabla 2 muestra la comparación de las TIEE para todas las localizaciones de cáncer en Medellín, con otros cuatro registros colombianos ubicados en Cali 32 , Bucaramanga 33 , Manizales 34 y Pasto 34 . La TIEE promedio anual fue de 144 por cada 100,000 hombres y de 145 por cada 100,000 mujeres en el periodo 2010-2014.…”

“… Localizaciones RPC. Tasas de Incidencia 2008-2012¶ Medellín (RPC-A) 2010-2014 Cali 30 Bucaramanga ( 31 ) Manizales 34 Pasto 32 Hombres Mujeres Hombres Mujeres Hombres Mujeres Hombres Mujeres Hombres Mujeres Estómago 20.3 10.8 17.3 10.3 20.3 9.7 26.5 11.9 12.3 8.1 Próstata 60.1 41.1 44.1 27.1 38.6 Colon 10.5 9.7 9.5 9.9 8.4 …”

Epidemiology of cancer in Colombia

“…The PBCR-Cali 7 , PBC-Manizales 10 and the hospital-based cancer registry (HBC-Registry) of the NCI-Colombia 13 , the only HBC-Registry in the country, present survival data for the types of cancer with the highest morbidity in Colombia: prostate, breast, cervix, colon and stomach.…”

“…The NCI-Colombia characterizes the current situation of the supply of oncological services in Colombia 14 , and it demonstrates that the certification of cancer deaths in Colombia is of good quality 15 . The NCI-Colombia uses the information from four cancer registers 7 - 10 and the official mortality figures, to make valid estimates of cancer incidence for the entire country and for each one of the provinces in Colombia 15 . The cancer risk estimates for Colombia will be more precise when the information from Barranquilla 11 and Medellín 12 can be included in the future.…”