PDF(Pubmed)
Abstract：
BACKGROUND: People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval.
METHODS: This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis.
RESULTS: A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest.
CONCLUSIONS: These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
METHODS: This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis.
RESULTS: A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest.
CONCLUSIONS: These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
摘要：
背景：低收入人群在整个癌症治疗过程中的预后较差；然而，对收入和诊断间隔知之甚少。我们通过邻里收入描述了诊断途径，并研究了收入与诊断间隔之间的关系。
方法：这是一项回顾性队列研究，使用常规收集的数据对安大略省2007-2019年诊断的结肠癌患者进行。诊断间隔定义为从第一次结肠癌遇到到诊断的天数。无症状途径被定义为在急诊科未发生的首次结肠镜检查或愈创木脂粪便隐血检查，并与症状途径分开检查。分位数回归用于确定邻居收入五分位数与控制年龄的条件第50和第90百分位数诊断间隔之间的关联，性别,农村住宅,和诊断年份。
结果：共纳入64,303例结肠癌患者。居住在最低收入社区的患者更有可能通过有症状的途径和急诊科进行诊断。与生活在最高收入社区的患者相比，生活在低收入社区的患者与第50和第90百分位数的症状诊断间隔更长有关。例如,与最高收入地区相比,生活在最低收入地区的患者的第90百分位数诊断间隔延长了15天(95%CI6-23).
结论：这些发现揭示了结肠癌诊断阶段的收入不平等。未来的工作应确定减少诊断间隔不平等的途径，并从公平的角度评估筛查和诊断评估计划。
方法：这是一项回顾性队列研究，使用常规收集的数据对安大略省2007-2019年诊断的结肠癌患者进行。诊断间隔定义为从第一次结肠癌遇到到诊断的天数。无症状途径被定义为在急诊科未发生的首次结肠镜检查或愈创木脂粪便隐血检查，并与症状途径分开检查。分位数回归用于确定邻居收入五分位数与控制年龄的条件第50和第90百分位数诊断间隔之间的关联，性别,农村住宅,和诊断年份。
结果：共纳入64,303例结肠癌患者。居住在最低收入社区的患者更有可能通过有症状的途径和急诊科进行诊断。与生活在最高收入社区的患者相比，生活在低收入社区的患者与第50和第90百分位数的症状诊断间隔更长有关。例如,与最高收入地区相比,生活在最低收入地区的患者的第90百分位数诊断间隔延长了15天(95%CI6-23).
结论：这些发现揭示了结肠癌诊断阶段的收入不平等。未来的工作应确定减少诊断间隔不平等的途径，并从公平的角度评估筛查和诊断评估计划。
