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Abstract #145377
Audio (mp3) recordingKevin M. Gorey, PhD, MSW1, Karen Y. Fung, PhD2, Isaac N. Luginaah, PhD3, Emma Bartfay, PhD4, Caroline Hamm, MD5, Frances C. Wright, MD, MEd6, Madhan Balagurusamy, MSc2, Aziz Mohammad, MSc2, Eric J. Holowaty, MD7, and Kathy X. Tang, MSc3. (1) School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada, 519-253-3000 ext. 3085, gorey@uwindsor.ca, (2) Department of Mathematics and Statistics, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada, (3) Department of Geography, University of Western Ontario, 1409 Social Sciences Building, London, ON N6A 5C2, Canada, (4) Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street, N., Oshawa, ON L1H 7L7, Canada, (5) Department of Medical Oncology, Windsor Regional Cancer Center, 2220 Kildare Road, Windsor, ON N8W 2X3, Canada, (6) Department of Surgery, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada, (7) Cancer Surveillance Unit, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7, Canada
Breast cancer survival is a sentinel indicator of health care performance. This study examined whether place and socioeconomic status had differential effects on the survival of women diagnosed with breast cancer in Ontario during the 1980s and the 1990s. Methods: The Ontario Cancer Registry provided 29,934 primary malignant breast cancers among women 25 years of age or older. Successive historical cohorts (1986-1988 and 1995-1997) were, respectively, followed until 1994 and 2003. Diverse places were compared: the greater metropolitan Toronto (GMT) area, other cities, ranging in size from 50,000 to a million people, smaller towns and villages, and rural and remote places. Neighborhood or community-level income data for each woman's residence at the time of diagnosis were taken from 1986 and 1996 population censuses. Results: Small cities with populations between 50,000 and 100,000 that comprised only 6% of the study sample were the only places where breast cancer survival had advanced less than the province as a whole. And in stark contrast to well-documented income-related disadvantages in similar United States places, substantial income-breast cancer survival equity was observed in such diverse places as the GMT megalopolis and remote places that are more than 300 km from urban centers. Conclusion: This historical analysis of breast cancer survival evidenced remarkably equitable advances across nearly all of Ontario's diverse places. The most likely explanation for such substantial equity seems to be Canada's universally accessible, single-payer, health care system.
Learning Objectives:
- To be able to articulate the historical, theoretical and political contexts within which contemporary North American (Canadian and American) health care policies developed.
- To be able to articulate the historical evidence on relative income-health outcome equities that empirically affirms the advantages of a universally accessible health care system such as Canada's.
- To understand how observational epidemiologic, particularly historical cohort, studies can provide practical evidence to steer future social policies.
Keywords: Access to Health Care, Social Inequalities
Related Web page: www.uwindsor.ca/gorey
Presenting author's disclosure statement:
Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA