Abstract
BackgroundPrevious studies indicate an effect of sociodemographic factors on risk for being diagnosed with, as well as on survival of cancer in general. Our primary aim was to analyse sociodemographic factors, resource use and lead times in health care after diagnosis with high grade malignant glioma (HGG) in a large population based cohort.MethodsA register-based study using several unique high-coverage registries. All patients over the age of 18 diagnosed with HGG in the Swedish Stockholm–Gotland region between 2001 and 2013 (n = 1149) were included.ResultsIn multivariable cox proportional hazard model of survival, older age, male sex and high tumour grade were associated with worse survival. No significant differences could be seen related to country of birth. A high disposable income was associated with better survival and fewer occasions of pre-diagnostic inpatient care. Older age and comorbidities were correlated with a significantly increased number of outpatient visits the year before HGG diagnosis. In addition, male sex, being born outside Sweden was associated to a higher number of outpatient visits the year after diagnosis in multivariable analysis. Leadtime from diagnosis (first suspicion on brain scan) to surgery showed that the oldest patients, patients with comorbidity and patients born outside Europe had to wait longer for surgery.ConclusionsSociodemographic factors like education, income and country of birth have impact on care processes both before and after the diagnosis HGG. This needs to be acknowledged in addition to important clinical factors like age, comorbidity and tumour grade, in order to accomplish more equal cancer care.
Highlights
Diagnosis and treatment of high grade glioma (HGG) have been improved during the last years, still the prognosis is poor
Throughout 2015 was used to follow patients in terms of resource use and survival after data of diagnosis.The study population was all patients in the Stockholm region, diagnosed with high-grade glioma according to SNOMED histopathological classification [13] reported in the Swedish Cancer Register (SCR)
Data on health care resource use was not available for patients living outside the region, why analysis of comorbidities and of health care resource use are based on the Stockholm population only (n = 845)
Summary
Diagnosis and treatment of high grade glioma (HGG) have been improved during the last years, still the prognosis is poor. An increasing number of reports present that comorbidities and sociodemographic factors such as education, income level or country of birth,. Our primary aim was to analyse sociodemographic factors, resource use and lead times in health care after diagnosis with high grade malignant glioma (HGG) in a large population based cohort. Male sex, being born outside Sweden was associated to a higher number of outpatient visits the year after diagnosis in multivariable analysis. Conclusions Sociodemographic factors like education, income and country of birth have impact on care processes both before and after the diagnosis HGG. This needs to be acknowledged in addition to important clinical factors like age, comorbidity and tumour grade, in order to accomplish more equal cancer care
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