Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study
Objectives Regional variation in cancer survival is an important health system performance measurement. We evaluated if regional variation in colon cancer survival may be driven by differences in the patient population, their health and healthcare utilisation, and/or cancer care delivery.Design Popu...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/9/e059597.full |
| _version_ | 1811251353182273536 |
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| author | Marlo Whitehead Christopher M Booth Timothy P Hanna Patti A Groome Michael Brundage Colleen Webber Erin Kennedy Weidong Kong Yingwei Peng |
| author_facet | Marlo Whitehead Christopher M Booth Timothy P Hanna Patti A Groome Michael Brundage Colleen Webber Erin Kennedy Weidong Kong Yingwei Peng |
| author_sort | Marlo Whitehead |
| collection | DOAJ |
| description | Objectives Regional variation in cancer survival is an important health system performance measurement. We evaluated if regional variation in colon cancer survival may be driven by differences in the patient population, their health and healthcare utilisation, and/or cancer care delivery.Design Population-based retrospective cohort study using routinely collected linked health administrative data.Setting Ontario, Canada.Participants Patients with colon cancer diagnosed between 1 January 2009 and 31 December 2012.Outcome Cancer-specific survival was compared across the province’s 14 health regions. Using accelerated failure time models, we assessed whether regional survival variations were mediated through differences in case mix, including age, sex, comorbidities, stage at diagnosis and colon subsite, potential marginalisation and/or prediagnosis healthcare.Results The study population included 16 895 patients with colon cancer. There was statistically significant regional variation in cancer-specific survival. Three regions had cancer-specific survival that was between 30% (95% CI 1.03 to 1.65) and 39% (95% CI 1.13 to 1.71) longer and one region had cancer-specific survival that was 26% shorter (95% CI 0.58 to 0.93) than the reference region. For three of these regions, case mix explained between 26% and 56% of the survival variation. Further adjustment for rurality explained 22% of the remaining survival variation in one region. Adjustment for continuity of primary care and the diagnostic interval length explained 10% and 11% of the remaining survival variation in two other regions. Socioeconomic marginalisation, recent immigration and colonoscopy history did not explain colon cancer survival variation.Conclusions Case mix accounted for much of the regional variation in colon cancer survival, indicating that efforts to monitor the quality of cancer care through survival metrics should consider case mix when reporting regional survival differences. Future work should repeat this approach in other settings and other cancer sites considering a broad range of potential mediators. |
| first_indexed | 2024-04-12T16:18:17Z |
| format | Article |
| id | doaj.art-7393a8c5f56e4bdbb85cd74f85a583a8 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-12T16:18:17Z |
| publishDate | 2022-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-7393a8c5f56e4bdbb85cd74f85a583a82022-12-22T03:25:39ZengBMJ Publishing GroupBMJ Open2044-60552022-09-0112910.1136/bmjopen-2021-059597Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort studyMarlo Whitehead0Christopher M Booth1Timothy P Hanna2Patti A Groome3Michael Brundage4Colleen Webber5Erin Kennedy6Weidong Kong7Yingwei Peng8ICES, Toronto, Ontario, Canadaclinical directorDepartment of Public Health Sciences, Queen`s University, Kingston, Ontario, Canada5 Division of Cancer Care and Epidemiology and Department of Public Health Sciences, Queen`s University, Kingston, Ontario, Canadaprofessor of oncology and public health sciencesOttawa Hospital Research Institute, Ottawa, Ontario, CanadaUniversity of Toronto, Toronto, Ontario, CanadaDivision of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario, CanadaDepartment of Public Health Sciences, Queen`s University, Kingston, Ontario, CanadaObjectives Regional variation in cancer survival is an important health system performance measurement. We evaluated if regional variation in colon cancer survival may be driven by differences in the patient population, their health and healthcare utilisation, and/or cancer care delivery.Design Population-based retrospective cohort study using routinely collected linked health administrative data.Setting Ontario, Canada.Participants Patients with colon cancer diagnosed between 1 January 2009 and 31 December 2012.Outcome Cancer-specific survival was compared across the province’s 14 health regions. Using accelerated failure time models, we assessed whether regional survival variations were mediated through differences in case mix, including age, sex, comorbidities, stage at diagnosis and colon subsite, potential marginalisation and/or prediagnosis healthcare.Results The study population included 16 895 patients with colon cancer. There was statistically significant regional variation in cancer-specific survival. Three regions had cancer-specific survival that was between 30% (95% CI 1.03 to 1.65) and 39% (95% CI 1.13 to 1.71) longer and one region had cancer-specific survival that was 26% shorter (95% CI 0.58 to 0.93) than the reference region. For three of these regions, case mix explained between 26% and 56% of the survival variation. Further adjustment for rurality explained 22% of the remaining survival variation in one region. Adjustment for continuity of primary care and the diagnostic interval length explained 10% and 11% of the remaining survival variation in two other regions. Socioeconomic marginalisation, recent immigration and colonoscopy history did not explain colon cancer survival variation.Conclusions Case mix accounted for much of the regional variation in colon cancer survival, indicating that efforts to monitor the quality of cancer care through survival metrics should consider case mix when reporting regional survival differences. Future work should repeat this approach in other settings and other cancer sites considering a broad range of potential mediators.https://bmjopen.bmj.com/content/12/9/e059597.full |
| spellingShingle | Marlo Whitehead Christopher M Booth Timothy P Hanna Patti A Groome Michael Brundage Colleen Webber Erin Kennedy Weidong Kong Yingwei Peng Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study BMJ Open |
| title | Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study |
| title_full | Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study |
| title_fullStr | Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study |
| title_full_unstemmed | Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study |
| title_short | Explaining regional variations in colon cancer survival in Ontario, Canada: a population-based retrospective cohort study |
| title_sort | explaining regional variations in colon cancer survival in ontario canada a population based retrospective cohort study |
| url | https://bmjopen.bmj.com/content/12/9/e059597.full |
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