Socioeconomic inequalities in hospital access for prostate cancer before and after COVID-19

Abstract

Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.