Journal of Public Health Medicine 22:343-348 (2000)
© 2000 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas
KM Gorey0,z
EJ Holowaty1
G Fehringer1
E Laukkanen2
NL Richter0
CM Meyer0
0 School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor Ontario N9B 3P4, Canada
1 Cancer Care Ontario, 620 University Avenue, Toronto, Ontario M5G 2L7, Canada
2 Windsor Regional Cancer Center, Metropolitan Campus, 2220 Kildare Road, Windsor Ontario N8W 2X3, Canada
z Corresponding author
E-mail: gorey@uwindsor.ca
Background.This study of cancer survival compared adults in Toronto, Ontario and three US metropolitan areas: Seattle, Washington; San Francisco, California; and Hartford, Connecticut. It examined whether socioeconomic status has a differential effect on cancer survival in Canada and the United States.
Method.The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) programme provided a total of 23 437 and 37 329 population-based primary malignant cancer cases for the Toronto and US samples, respectively (1986-1988, followed until 1994). Census-based measures of socio-economic status were used to ecologically control absolute income status.
Results.Among residents of low-income areas, persons in Toronto experienced a 5 year survival advantage for 13 of 15 cancer sites [minimally one gender significant at 95 per cent confidence interval (CI)]. An aggregate 35 per cent survival advantage among the Canadian cohort was demonstrated (survival rate ratio (SSR) = 1.35, 95 per cent CI = 1.30-1.40), and this effect was even larger among younger patients not yet eligible for Medicare coverage in the United States (SRR = 1.46, 95 per cent CI = 1.40-1.52).
Conclusion.Systematically replicating a previous Toronto-Detroit comparison, this study's observed consistent pattern of Canadian survival advantage across various cancer sites suggests that their more equitable access to preventive and therapeutic health care services may be responsible for the difference.
Keywords: cancer survival, socioeconomic factors, health care, health insurance, international, race, ethnicity, population-based
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