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Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study.

Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J - BMC Health Serv Res (2008)

Bottom Line: Delay was categorised as short or long based on quartiles.In regard to system delay, female patients with a large household fortune experienced shorter delays (OR 0.46, 95%CI 0.21 to 0.99) than economically less privileged women, while female patients with a high alcohol intake experienced longer delays (OR 2.82, 95%CI 1.18 to 6.72) than women with an average intake.Future research should examine a broader array of patients' personal characteristics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit and Department of General Practice, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. rph@alm.au.dk.

ABSTRACT

Background: Delay in cancer diagnosis may be important for cancer prognosis. Large individual variations in the duration of delay have been observed. This study examines whether patients' socioeconomic characteristics are predictors of long patient-, doctor- and system-related delay in cancer diagnosis.

Methods: Danish population-based cohort study. From September 2004 to September 2005, newly diagnosed cancer patients were enrolled from administrative registries. A total of 467 general practitioners in the County of Aarhus, Denmark, completed questionnaires on 2,212 cancer patients' diagnostic pathways. A total of 1,252 cancer patients filled in questionnaires on their socioeconomic characteristics (e.g. marital status, education, occupation, household income and fortune). Delay was categorised as short or long based on quartiles. Predictors of long delay were assessed in a logistic regression model using odds ratios (ORs) as a proxy of relative risks.

Results: In regard to patient delay, retired female patients experienced shorter delays (OR 0.35, 95% confidence interval (95%CI) 0.13 to 0.98) than employed female patients, while female smokers experienced longer delays (OR 2.42, 95%CI 1.21 to 4.85) than female non-smokers. In regard to doctor delay, female patients with a large household fortune experienced shorter delays (OR 0.07, 95%CI 0.01 to 0.45) than economically less privileged female patients. Well-educated men experienced shorter delays (OR 0.40, 95%CI 0.16 to 1.00) than men with short education. Male patients experienced longer doctor delays (OR 2.11, 95%CI 1.11 to 4.02) than women when gender-specific cancers were excluded. In regard to system delay, female patients with a large household fortune experienced shorter delays (OR 0.46, 95%CI 0.21 to 0.99) than economically less privileged women, while female patients with a high alcohol intake experienced longer delays (OR 2.82, 95%CI 1.18 to 6.72) than women with an average intake.

Conclusion: We found socioeconomic predictors of delay that allow us to hypothesize social inequalities in the distribution of delay, but, in general, only a few socioeconomic variables predicted delay in cancer diagnosis. Future research should examine a broader array of patients' personal characteristics.

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Catagorisation of delay.
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Figure 1: Catagorisation of delay.

Mentions: Delay was calculated on the basis of dates provided by the GPs. As shown in Figure 1, three sources of delay were identified: patient delay (median 21 days, interquartile interval (IQI) 7 to 56), doctor delay (median 0, IQI 0 to 2) and system delay (median 55, IQI 32 to 93) (Hansen et al: Where does delay occur in cancer diagnosis? A cohort study of delay duration in 2,212 newly diagnosed cancer patients, submitted). Delay was categorised as either short or long delay, with long delay defined as the 4th quartile of all patients' delay and the remaining delay defined as short. Because the 75th percentile for doctor delay was only 2 days (see above), we used a cut-off of 30 days (corresponding to the 91st percentile) to classify short versus long doctor delay. It is clinically appropriate for patients and GPs, as watchful waiting of a few weeks' duration is often a part of a standard diagnostic investigation [21]. Thus, long patient delay was set to > 60 days, long doctor delay to > 30 days and long system delay to > 90 days.


Socioeconomic patient characteristics predict delay in cancer diagnosis: a Danish cohort study.

Hansen RP, Olesen F, Sørensen HT, Sokolowski I, Søndergaard J - BMC Health Serv Res (2008)

Catagorisation of delay.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2311301&req=5

Figure 1: Catagorisation of delay.
Mentions: Delay was calculated on the basis of dates provided by the GPs. As shown in Figure 1, three sources of delay were identified: patient delay (median 21 days, interquartile interval (IQI) 7 to 56), doctor delay (median 0, IQI 0 to 2) and system delay (median 55, IQI 32 to 93) (Hansen et al: Where does delay occur in cancer diagnosis? A cohort study of delay duration in 2,212 newly diagnosed cancer patients, submitted). Delay was categorised as either short or long delay, with long delay defined as the 4th quartile of all patients' delay and the remaining delay defined as short. Because the 75th percentile for doctor delay was only 2 days (see above), we used a cut-off of 30 days (corresponding to the 91st percentile) to classify short versus long doctor delay. It is clinically appropriate for patients and GPs, as watchful waiting of a few weeks' duration is often a part of a standard diagnostic investigation [21]. Thus, long patient delay was set to > 60 days, long doctor delay to > 30 days and long system delay to > 90 days.

Bottom Line: Delay was categorised as short or long based on quartiles.In regard to system delay, female patients with a large household fortune experienced shorter delays (OR 0.46, 95%CI 0.21 to 0.99) than economically less privileged women, while female patients with a high alcohol intake experienced longer delays (OR 2.82, 95%CI 1.18 to 6.72) than women with an average intake.Future research should examine a broader array of patients' personal characteristics.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit and Department of General Practice, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. rph@alm.au.dk.

ABSTRACT

Background: Delay in cancer diagnosis may be important for cancer prognosis. Large individual variations in the duration of delay have been observed. This study examines whether patients' socioeconomic characteristics are predictors of long patient-, doctor- and system-related delay in cancer diagnosis.

Methods: Danish population-based cohort study. From September 2004 to September 2005, newly diagnosed cancer patients were enrolled from administrative registries. A total of 467 general practitioners in the County of Aarhus, Denmark, completed questionnaires on 2,212 cancer patients' diagnostic pathways. A total of 1,252 cancer patients filled in questionnaires on their socioeconomic characteristics (e.g. marital status, education, occupation, household income and fortune). Delay was categorised as short or long based on quartiles. Predictors of long delay were assessed in a logistic regression model using odds ratios (ORs) as a proxy of relative risks.

Results: In regard to patient delay, retired female patients experienced shorter delays (OR 0.35, 95% confidence interval (95%CI) 0.13 to 0.98) than employed female patients, while female smokers experienced longer delays (OR 2.42, 95%CI 1.21 to 4.85) than female non-smokers. In regard to doctor delay, female patients with a large household fortune experienced shorter delays (OR 0.07, 95%CI 0.01 to 0.45) than economically less privileged female patients. Well-educated men experienced shorter delays (OR 0.40, 95%CI 0.16 to 1.00) than men with short education. Male patients experienced longer doctor delays (OR 2.11, 95%CI 1.11 to 4.02) than women when gender-specific cancers were excluded. In regard to system delay, female patients with a large household fortune experienced shorter delays (OR 0.46, 95%CI 0.21 to 0.99) than economically less privileged women, while female patients with a high alcohol intake experienced longer delays (OR 2.82, 95%CI 1.18 to 6.72) than women with an average intake.

Conclusion: We found socioeconomic predictors of delay that allow us to hypothesize social inequalities in the distribution of delay, but, in general, only a few socioeconomic variables predicted delay in cancer diagnosis. Future research should examine a broader array of patients' personal characteristics.

Show MeSH
Related in: MedlinePlus