Variation in colon cancer survival for patients living and receiving care in London, 2006–2013: does where you live matter?

BackgroundMarked geographical disparities in survival from colon cancer have been consistently described in England. Similar patterns have been observed within London, almost mimicking a microcosm of the country’s survival patterns. This evidence has suggested that the area of residence plays an imp...

Full description

Saved in:
Bibliographic Details
Published in:Journal of epidemiology and community health (1979) Vol. 76; no. 2; pp. 196 - 205
Main Authors: Quaresma, Manuela, Carpenter, James R, Turculet, Adrian, Rachet, Bernard
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01.02.2022
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects:
Algorithms
Bayes Theorem
Bayesian analysis
Colon cancer
Colonic Neoplasms - therapy
Colorectal cancer
COVID-19
Diagnosis
Emergency medical care
Geographical variations
geography
Health care access
health policy
Hospitals
Humans
inequalities
London - epidemiology
Mimicry
multilevel modelling
neoplasms
Original Research
Pandemics
Patients
SARS-CoV-2
Socioeconomic factors
Software
Survival
Survival Analysis
London
United Kingdom > UK
England
inequalities
multilevel modelling
health policy
neoplasms
geography
ISSN:0143-005X, 1470-2738, 1470-2738
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BackgroundMarked geographical disparities in survival from colon cancer have been consistently described in England. Similar patterns have been observed within London, almost mimicking a microcosm of the country’s survival patterns. This evidence has suggested that the area of residence plays an important role in the survival from cancer.MethodsWe analysed the survival from colon cancer of patients diagnosed in 2006–2013, in a pre-pandemic period, living in London at their diagnosis and received care in a London hospital. We examined the patterns of patient pathways between the area of residence and the hospital of care using flow maps, and we investigated whether geographical variations in survival from colon cancer are associated with the hospital of care. To estimate survival, we applied a Bayesian excess hazard model which accounts for the hierarchical structure of the data.ResultsGeographical disparities in colon cancer survival disappeared once controlled for hospitals, and the disparities seemed to be augmented between hospitals. However, close examination of patient pathways revealed that the poorer survival observed in some hospitals was mostly associated with higher proportions of emergency diagnosis, while their performance was generally as expected for patients diagnosed through non-emergency routes.DiscussionThis study highlights the need to better coordinate primary and secondary care sectors in some areas of London to improve timely access to specialised clinicians and diagnostic tests. This challenge remains crucially relevant after the recent successive regroupings of Clinical Commissioning Groups (which grouped struggling areas together) and the observed exacerbation of disparities during the COVID-19 pandemic.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ISSN:0143-005X
1470-2738
1470-2738
DOI:10.1136/jech-2021-217043