Abstract
ObjectiveThis study aimed to examine the urban-rural disparities and associated factors of health care utilization among cancer patients in China.MethodsThis study used the data collected from a cross-sectional survey conducted in China. A total of 1,570 cancer survivors from three urban districts and five rural counties were selected by using a multistage stratified random sampling method. We measured health care utilization with the way of cancer diagnosis, the number of hospitals visited, and receiving alternative therapies. Chi-square test was used to examine the differences between urban and rural cancer patients. Binary logistic regression analysis was performed to explore the determinants of health care utilization.ResultsAmong 1,570 participants, 84.1% were diagnosed with cancer after developing symptoms, 55.6% had visited two and above hospitals, and 5.7% had received alternative therapies. Compared with urban cancer patients, rural ones were more likely to be diagnosed with cancer after developing symptoms (χ2 = 40.04, p < 0.001), while they were less likely to visit more than one hospital (χ2 = 27.14, p < 0.001). Residence area (urban/rural), health insurance type, household income, age at diagnosis, tumor site, stage of tumor, and survival years were significantly associated with health care utilization of cancer patients (p < 0.01).ConclusionsHealth care utilization was suboptimal among cancers patients in China. Rural cancer patients had less health care utilization including screenings and treatments than urban ones. Policymakers should implement specific strategies to ensure equitable utilization of cancer care. More attention should be paid to the disadvantaged groups and rural cancer patients. Prioritizing health resources allocation is needed to prevent, screen, and treat cancers in rural areas.
Highlights
Globalcancer statistics estimated 18.1 million new cancer cases around the world in 2018, and out of these cases, nearly one-half occurred in Asia, 23.4% occurred in Europe, and 21% occurred in America
Cancer patients having higher household income were less likely to be diagnosed with cancer after developing symptoms (OR = 0.53, p < 0.05; Odds Ratios (ORs) = 0.54, p < 0.05; OR = 0.48, p < 0.05), while were more likely to visit more than one hospitals (OR = 2.02, p < 0.01)
Compared with breast cancer patients, lung cancer patients were more likely to visit more than one hospitals (OR = 1.55, p < 0.05); colorectal cancer patients were more likely to be diagnosed with cancer after developing symptoms (OR = 1.65, p < 0.05)
Summary
Globalcancer statistics estimated 18.1 million new cancer cases around the world in 2018, and out of these cases, nearly one-half occurred in Asia, 23.4% occurred in Europe, and 21% occurred in America. Thereinto, ∼24% of cancer cases occurred in China [1]. With the increasing incidence of cancer, the population burden of cancer is being more and more significant in China. Southwest China has the highest cancer incidence rate, followed by North China and Northwest China, and Central China has the lowest incidence rate [2]. Cancer has become the leading cause of death (126.9 deaths per 100,000 persons) and a major economic burden in China [2, 3]. In 2011, five types of most prevalent cancers (lung, stomach, colorectal, female breast, and esophageal cancers) accounted for 56% of the cancer burden in China [4]. Improved detection methods and more effective therapies for cancer have been developed and applied in clinical practice, which has led to the increasing number of cancer survivors [5, 6]. Cancer has become one of the most significant public health issues in China [7]
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