Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study
Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study
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DOI：
10.18632/oncotarget.6274
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发表时间：
2016-01-05
期刊：
影响因子：
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通讯作者：
Chauvin, Franck
中科院分区：
文献类型：
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作者：
Moriceau, Guillaume;Bourmaud, Aurelie;Chauvin, Franck
欧洲贫困指数（EDI）是一种新的社会经济地位（SES）生态评估。本研究假设，治疗时间可以被用来作为癌症的护理质量的替代品，以确定癌症患者的SES和护理质量之间的关联在法国综合cancer center.Methods：回顾性单中心队列研究。2013年1月至2013年12月期间，所有连续入院的确诊为乳腺癌（BC）、前列腺癌（PC）、结直肠癌（CRC）、肺癌（LC）或肉瘤（S）的成年患者均被纳入其中。EDI和诊断时间（TTD），以及治疗时间（TTT）的关联进行了分析，使用考克斯回归，并进行分层分析每个肿瘤部位。原始肿瘤部位为505例BC（52%）、169例PC（17%）、145例LC（15%）、116例CRC（12%）和34例S（4%）。中位TTD为1.41个月（Q1-Q3为0.5至3.5个月）。中位TTT为0.9个月（0.4 - 1.4）。在多变量分析中，我们将肿瘤部位确定为影响TTD的预测因素，BC（0.75个月，[ 0.30-1.9]）比PC（4.69个月[ 1.6-29.7]）短，HR 0.27 95% CI = [0.22-0.34]，p < 0.001。BC的TTT（0.75个月[ 0.4-1.1]）也短于PC（2.02 [0.9-3.2]），HR 0.32 95% CI = [ 0.27-0.39]，p < 0.001。EDI五分位数没有发现与TTT或TTD.Conclusions：估计的EDI延迟似乎并不相关的诊断时间或治疗时间在我们的现实生活中的人口的延长。应该做进一步的研究，以确定其他脆弱的敏感因素，可能是负责延迟护理。
Context: The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center.Methods: retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed.Results: 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [ 0.30-1.9]) than PC (4.69 months [ 1.6-29.7]), HR 0.27 95% CI = [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [ 0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95% CI = [ 0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD.Conclusions: Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.