145377 Breast cancer survival in Ontario, 1986 to 2003: Equitable advances across diverse urban and rural places

Monday, November 5, 2007: 8:30 AM

Kevin M. Gorey, PhD, MSW , School of Social Work, University of Windsor, Windsor, ON, Canada
Karen Y. Fung, PhD , Department of Mathematics and Statistics, University of Windsor, Windsor, ON, Canada
Isaac N. Luginaah, PhD , Department of Geography, University of Western Ontario, London, ON, Canada
Emma Bartfay, PhD , Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
Caroline Hamm, MD , Department of Medical Oncology, Windsor Regional Cancer Center, Windsor, ON, Canada
Frances C. Wright, MD, MEd , Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Toronto, ON, Canada
Madhan K. Balagurusamy, MSc , Department of Mathematics and Statistics, University of Windsor, Windsor, ON, Canada
Aziz Mohammad, MSc , Department of Mathematics and Statistics, University of Windsor, Windsor, ON, Canada
Eric J. Holowaty, MD , Population Studies and Surveillance, Cancer Care Ontario, Toronto, ON, Canada
Kathy X. Tang, MSc , Department of Geography, University of Western Ontario, London, ON, 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:
1. To be able to articulate the historical, theoretical and political contexts within which contemporary North American (Canadian and American) health care policies developed. 2. 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. 3. 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

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.

See more of: Health Policies: The Uninsured and Healthcare Coverage and Access
See more of: Social Work