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Endometrial cancer presentation is associated with social determinants of health in a public healthcare system: A population-based cohort study.

Abstract：

OBJECTIVE:Delay in diagnosis of endometrial cancer may be associated with disease progression and impact management and outcomes. Social and cultural barriers influence recognition of symptoms and self-advocacy in seeking care. Associations between social determinants of health (SDH) and disease presentation have been shown in some settings. Our objective was to investigate these in Ontario's universal access system. METHODS:Endometrial cancer patients in Ontario diagnosed 2009-2017 were identified, and clinical, social and demographic information extracted from administrative databases using ICES (Institute of Evaluative Sciences) algorithms. SDH were quantified using previously validated marginalization indices for material deprivation, residential instability and ethnic concentration. Associations between SDH and disease stage were explored using logistic regression. RESULTS:20,228 patients were identified. 73% of cancers were confined to the uterus. Stage distribution differed across marginalization quintiles (p < 0.001) with advanced disease found more frequently in highly marginalized patients: 29% vs. 25% (p < 0.001) for material deprivation, OR = 1.06/quintile (CI, 1.03-1.09); 29% vs. 24% (p < 0.001) for ethnic concentration, OR = 1.05/quintile (CI, 1.03-1.08); 30% vs. 27% (p < 0.001) for residential instability, OR = 1.02/quintile (CI, 1.0-1.05). Marginalization was persistently associated with advanced disease on multivariable analysis adjusted for age, comorbidity score, obesity and disease histology (OR = 1.05/quintile, CI 1.01-1.10, p = 0.03). CONCLUSIONS:Socioeconomic marginalization is associated with advanced disease at presentation among endometrial cancer patients in Ontario. Mediators of this association are likely multifactorial, and need to be further investigated in order to create opportunities for improved patient education and advocacy, redistribution of resources and the promotion of health equity.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Helpman L,Pond GR,Elit L,Anderson LN,Seow H

doi

10.1016/j.ygyno.2020.04.693

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

130-136

issue

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(20)30993-8

journal_volume

158

pub_type

杂志文章

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Endometrial cancer presentation is associated with social determinants of health in a public healthcare system: A population-based cohort study.