The relationship between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 361-361
Author(s):  
Justin Oake ◽  
Oksana Harasemiw ◽  
Navdeep Tangri ◽  
Thomas Ferguson ◽  
Jeff W. Saranchuk ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Decision Making ◽  
Socioeconomic Status ◽  
Health Care System ◽  
Metastatic Prostate Cancer ◽  
Income Quintile ◽  
Nested Models ◽  
Treatment Type ◽  
Care System

361 Background: A large body of research has shown that there are strong socioeconomic disparities in access to cancer treatment. However, whether these inequalities persist among men with prostate cancer has not been previously explored in the equal-access, universal Canadian health care system. The aim of this study is to compare whether socioeconomic status is associated with the type of treatment received (radical prostatectomy (RP) versus radiation therapy (RT)) for men diagnosed with nonmetastatic prostate cancer in Manitoba, Canada. Methods: Men who were diagnosed with non-metastatic prostate cancer between 2004 and 2016 and subsequently treated with RP or RT were identified using the CancerCare Manitoba Registry and linked to provincial databases. SES was defined as neighbourhood income by postal code and divided into income quintiles (Q1-Q5, with Q1 the lowest quintile and Q5 the highest). Multivariable logistic regression nested models were used to compare whether socioeconomic status was associated with treatment type received. Results: We identified 4,560 individuals between 2004-2016 who were diagnosed with non-metastatic prostate cancer. 2,554 men were treated with RP and 2,006 with RT.As income quintile increased, men were more likely to undergo RP than RT (Q3 vs Q1: aOR 1.45 (1.09-1.92); Q5 vs. Q1: aOR 2.17, 95% CI 1.52-2.86). Conclusions: Despite a universal health care system, socioeconomic inequities are present for men seeking primary treatment for prostate cancer. Further investigation into the decision making process among patients diagnosed with prostate cancer may inform decision making to ameliorate these disparities.

Does Socioeconomic Status Affect Stage at Presentation for Larynx Cancer in Canada’s Universal Health Care System?

2018 ◽  
Vol 160 (3) ◽  
pp. 488-493 ◽  
Author(s):  
Diana Khalil ◽  
Martin J. Corsten ◽  
Margaret Holland ◽  
Adele Balram ◽  
James Ted McDonald ◽  
...  
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Health Care System ◽  
Laryngeal Cancer ◽  
Income Quintile ◽  
Universal Health Care ◽  
Urban Residence ◽  
Universal Health Care System ◽  
Universal Health ◽  
Care System

Objective Diagnosis of laryngeal cancer is dependent on awareness that persistent hoarseness needs to be investigated as well as access to an otolaryngologist. This study aimed to better classify and understand 3 factors that may lead to variability in stage at presentation of laryngeal cancer: (1) socioeconomic status (SES), (2) differences in access to health care by location of residence (rural vs urban or by province), and (3) access to an otolaryngologist (by otolaryngologists per capita). Study Design Registry-based multicenter cohort analysis. Setting This was a national study across Canada, a country with a single-payer, universal health care system. Subjects All persons 18 years or older who were diagnosed with laryngeal cancer from 2005 to 2013 inclusive were extracted from the Canadian Cancer Registry (CCR). Methods Ordered logistic regression was used to determine the effect of income, age, sex, province of residence, and rural vs urban residence on stage at presentation. Results A total of 1550 cases were included (1280 males and 265 females). The stage at presentation was earlier in the highest income quintile (quintile 5) compared to the lower income quintiles (quintiles 1-4) (odds ratio [OR], 0.68; P < .05). There was a statistically significant difference in stage at presentation based on rural or urban residence within the highest income quintile (OR, 1.73; P < .005). Conclusion There is a relationship between SES and stage at presentation for laryngeal cancer even in the Canadian universal health care system.

scholarly journals Looking beyond Administrative Health Care Data: The Role of Socioeconomic Status in Predicting Future High-cost Patients with Mental Health and Addiction: Voir au-delà des données administratives des soins de santé : le rôle du statut socio-économique pour prédire les patients à coût élevé en santé mentale et dépendance

2021 ◽  
pp. 070674372110048
Author(s):  
Claire de Oliveira ◽  
Luke Mondor ◽  
Walter P. Wodchis ◽  
Laura C. Rosella
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Socioeconomic Status ◽  
Mental Illness ◽  
Health Care System ◽  
Health Care Use ◽  
Public Health Care ◽  
Income Quintile ◽  
Health Care Data ◽  
Care System

Introduction: Previous research has shown that the socioeconomic status (SES)–health gradient also extends to high-cost patients; however, little work has examined high-cost patients with mental illness and/or addiction. The objective of this study was to examine associations between individual-, household- and area-level SES factors and future high-cost use among these patients. Methods: We linked survey data from adult participants (ages 18 and older) of 3 cycles of the Canadian Community Health Survey to administrative health care data from Ontario, Canada. Respondents with mental illness and/or addiction were identified based on prior mental health and addiction health care use and followed for 5 years for which we ascertained health care costs covered under the public health care system. We quantified associations between SES factors and becoming a high-cost patient (i.e., transitioning into the top 5%) using logistic regression models. For ordinal SES factors, such as income, education and marginalization variables, we measured absolute and relative inequalities using the slope and relative index of inequality. Results: Among our sample, lower personal income (odds ratio [ OR] = 2.11, 95% confidence interval [CI], 1.54 to 2.88, for CAD$0 to CAD$14,999), lower household income ( OR = 2.11, 95% CI, 1.49 to 2.99, for lowest income quintile), food insecurity ( OR = 1.87, 95% CI, 1.38 to 2.55) and non-homeownership ( OR = 1.34, 95% CI, 1.08 to 1.66), at the individual and household levels, respectively, and higher residential instability (OR = 1.72, 95% CI, 1.23 to 2.42, for most marginalized), at the area level, were associated with higher odds of becoming a high-cost patient within a 5-year period. Moreover, the inequality analysis suggested pro-high-SES gradients in high-cost transitions. Conclusions: Policies aimed at high-cost patients with mental illness and/or addiction, or those concerned with preventing individuals with these conditions from becoming high-cost patients in the health care system, should also consider non-clinical factors such as income as well as related dimensions including food security and homeownership.

Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System

2021 ◽  
Vol 41 (2) ◽  
pp. 120-132
Author(s):  
Kevin D. Li ◽  
Christopher S. Saigal ◽  
Megha D. Tandel ◽  
Lorna Kwan ◽  
Moira Inkelas ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Decision Making ◽  
Health Care System ◽  
Clinical Characteristics ◽  
Implementation Strategies ◽  
Shared Decision ◽  
Implementation Outcomes ◽  
Academic Center ◽  
Care System

Background Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. Methods We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. Results Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients’ records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. Conclusions Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.

scholarly journals Unmasking a health care system: the Dutch policy response to the Covid-19 crisis

2021 ◽  
pp. 1-10 ◽  
Author(s):  
Iris Wallenburg ◽  
Jan-Kees Helderman ◽  
Patrick Jeurissen ◽  
Roland Bal
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care System ◽  
Health Care Systems ◽  
Economic Policies ◽  
Hard Time ◽  
Dutch Health ◽  
Care Systems ◽  
Policy Systems ◽  
Care System

Abstract The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.

scholarly journals Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study

2019 ◽  
Vol 35 (3) ◽  
pp. 185-191 ◽  
Author(s):  
David A. Agom ◽  
Stuart Allen ◽  
Sarah Neill ◽  
Judith Sixsmith ◽  
Helen Poole ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Palliative Care ◽  
Qualitative Study ◽  
Health Care System ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Semistructured Interview ◽  
Design Data ◽  
Care System

Background: There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the health-care system in Nigeria or other African contexts may be influencing utilization of these services. Aim: This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. Methods: This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Findings: Three themes were identified: dysfunctional structural organization of the health-care delivery system, service-users’ economic status, and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological health care and PC. Conclusion: This article offers insights into the role of the health-care system, as organized currently in Nigeria, as “autoinhibitory” and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage, and increase mortality.

scholarly journals Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California

2014 ◽  
Vol 133 ◽  
pp. 156-157
Author(s):  
B.J. Long ◽  
J. Chang ◽  
A. Ziogas ◽  
K.S. Tewari ◽  
H. Anton-Culver ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Health Care ◽  
Socioeconomic Status ◽  
Health Care System ◽  
Advanced Stage ◽  
Care System
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