Effects of Socioeconomic Status on Colon Cancer Treatment Accessibility and Survival in Toronto, Ontario, and San Francisco, California, 1996-2006

We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California. We analyzed registry data for colon cancer patients from Ontario (n = 930) and California (n = 1014), diagnosed between 1996 and 2000 and followe...

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Bibliographic Details
Published in:American journal of public health (1971) 2011, Vol.101 (1), p.112-119
Main Authors: GOREY, Kevin M, LUGINAAH, Isaac N, BARTFAY, Emma, FUNG, Karen Y, HOLOWATY, Eric J, WRIGHT, Frances C, HAMM, Caroline, KANJEEKAL, Sindu M
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Breast cancer
Cancer therapies
Chemotherapy
Colonic Neoplasms - mortality
Colonic Neoplasms - therapy
Colorectal cancer
Disease
Early Diagnosis
Female
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Health insurance
Health Services Accessibility
Health Status Disparities
Humans
Likelihood Functions
Low income groups
Lymphatic system
Male
Medical prognosis
Medical sciences
Medical screening
Middle Aged
Miscellaneous
Missing data
Neighborhoods
Ontario - epidemiology
Poverty
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Radiation therapy
Research and Practice
San Francisco - epidemiology
Social Class
Socioeconomic factors
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Studies
Surgery
Survival Rate
Tumors
Waiting Lists
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Description
Summary:We examined the differential effects of socioeconomic status on colon cancer care and survival in Toronto, Ontario, Canada, and San Francisco, California. We analyzed registry data for colon cancer patients from Ontario (n = 930) and California (n = 1014), diagnosed between 1996 and 2000 and followed until 2006, on stage, surgery, adjuvant chemotherapy, and survival. We obtained socioeconomic data for individuals' residences from population censuses. Income was directly associated with lymph node evaluation, chemotherapy, and survival in San Francisco but not in Toronto. High-income persons had better survival rates in San Francisco than in Toronto. After adjustment for stage, survival was better for low-income residents of Toronto than for those of San Francisco. Middle- to low-income patients were more likely to receive indicated chemotherapy in Toronto than in San Francisco. Socioeconomic factors appear to mediate colon cancer care in urban areas of the United States but not in Canada. Improvements are needed in screening, diagnostic investigations, and treatment access among low-income Americans.
ISSN:0090-0036
1541-0048
DOI:10.2105/AJPH.2009.173112