Risk, Health and Decision Support Group

At the University of East Anglia, Norwich

Geographical access to healthcare in Northern England and post mortem diagnosis of cancer

Andy Jones , Robin Haynes , Bobbie Sauerzapf , Michael Crawford , David Forman

Background: There is some previous evidence that diagnosis of cancer at death, recorded as registry Death Certificate Only records, is associated with problems of access to care. Methods: Records from the Northern & Yorkshire Cancer Registry for patients registered with breast, colorectal, lung, ovarian or prostate cancer between 1994-2002 were supplemented with measures of travel time to general practitioner and hospital services, and social deprivation. Logistic regression was used to identify predictors of records where diagnosis was at death. Results: There was no association between the odds diagnosis at death and access to primary care. For all sites except breast, the highest odds of being a cancer diagnosed at death fell among those living in the highest quartile of hospital travel time, although it was only statistically significant for colorectal and ovary tumours. Those in the most deprived and furthest travel time to hospital quartile were 2.6 times more likely to be a diagnosis at death case compared to those in the most affluent and proximal areas. Conclusions: There is some evidence that poorer geographical access to tertiary care, in particular when coupled with social disadvantages, may be associated with increased odds of diagnosis at death.

Journal of Public Health, Advance on-line

http://dx.doi.org/10.1093/pubmed/fdq017