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Peter Vedsted

Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – An international comparison between Denmark and Scotland using data-linked cohorts

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Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – An international comparison between Denmark and Scotland using data-linked cohorts. / Murchie, Peter; Falborg, Alina Zalounina; Turner, Melanie; Vedsted, Peter; Virgilsen, Line F.

I: Cancer epidemiology, Bind 74, 102004, 10.2021.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

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@article{e84ad5d039c64fcb9c5fb5d6746debc3,
title = "Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – An international comparison between Denmark and Scotland using data-linked cohorts",
abstract = "Background: Rurald wellers with colorectal cancer have poorer outcomes than their urban counterparts. The reasons why are not known but are likely to be complex and be determined by an interplay between geography and health service organization. By comparing the associations related to travel-time to primary and secondary healthcare facilities in two neighbouring countries, Denmark and Scotland, we aimed to shed light on potential mechanisms. Methods: Analysis was based on two comprehensive cohorts of patients diagnosed with colorectal cancer in Denmark (2010−16) and Scotland (2007−14). Associations between travel-time and cancer pathway intervals, tumour stage at diagnosis and one-year mortality were analysed using generalised linear models. Travel-time was modelled using restricted cubic splines for each country and combined. Adjustments were made for key confounders. Results: Travel-time to key healthcare facilities influenced the diagnostic experience and outcomes of CRC patients from Scotland and Denmark to some extent differently. The longest travel-times to a specialised hospital appeared to afford the most rapid secondary care interval, whereas moderate travel-times to hospital (about 20−60 min) appeared to impact on later stage and greater one-year mortality in Scotland, but not in Denmark. A U-shaped association was seen between travel-time to the GP and one year-mortality. Conclusions: This is the first international data-linkage study to explore how different national geographies and health service structures may determine cancer outcomes. Future research should compare more countries and more cancer sites and evaluate the impact and implications of differences in national health service organisation.",
keywords = "Colorectal neoplasms, Diagnosis, Mortality, Neoplasm staging, Primary health care, Time-to-treatment, Travel",
author = "Peter Murchie and Falborg, {Alina Zalounina} and Melanie Turner and Peter Vedsted and Virgilsen, {Line F.}",
note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",
year = "2021",
month = oct,
doi = "10.1016/j.canep.2021.102004",
language = "English",
volume = "74",
journal = "Cancer Epidemiology",
issn = "1877-7821",
publisher = "Elsevier Inc.",

}

RIS

TY - JOUR

T1 - Geographic variation in diagnostic and treatment interval, cancer stage and mortality among colorectal patients – An international comparison between Denmark and Scotland using data-linked cohorts

AU - Murchie, Peter

AU - Falborg, Alina Zalounina

AU - Turner, Melanie

AU - Vedsted, Peter

AU - Virgilsen, Line F.

N1 - Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021/10

Y1 - 2021/10

N2 - Background: Rurald wellers with colorectal cancer have poorer outcomes than their urban counterparts. The reasons why are not known but are likely to be complex and be determined by an interplay between geography and health service organization. By comparing the associations related to travel-time to primary and secondary healthcare facilities in two neighbouring countries, Denmark and Scotland, we aimed to shed light on potential mechanisms. Methods: Analysis was based on two comprehensive cohorts of patients diagnosed with colorectal cancer in Denmark (2010−16) and Scotland (2007−14). Associations between travel-time and cancer pathway intervals, tumour stage at diagnosis and one-year mortality were analysed using generalised linear models. Travel-time was modelled using restricted cubic splines for each country and combined. Adjustments were made for key confounders. Results: Travel-time to key healthcare facilities influenced the diagnostic experience and outcomes of CRC patients from Scotland and Denmark to some extent differently. The longest travel-times to a specialised hospital appeared to afford the most rapid secondary care interval, whereas moderate travel-times to hospital (about 20−60 min) appeared to impact on later stage and greater one-year mortality in Scotland, but not in Denmark. A U-shaped association was seen between travel-time to the GP and one year-mortality. Conclusions: This is the first international data-linkage study to explore how different national geographies and health service structures may determine cancer outcomes. Future research should compare more countries and more cancer sites and evaluate the impact and implications of differences in national health service organisation.

AB - Background: Rurald wellers with colorectal cancer have poorer outcomes than their urban counterparts. The reasons why are not known but are likely to be complex and be determined by an interplay between geography and health service organization. By comparing the associations related to travel-time to primary and secondary healthcare facilities in two neighbouring countries, Denmark and Scotland, we aimed to shed light on potential mechanisms. Methods: Analysis was based on two comprehensive cohorts of patients diagnosed with colorectal cancer in Denmark (2010−16) and Scotland (2007−14). Associations between travel-time and cancer pathway intervals, tumour stage at diagnosis and one-year mortality were analysed using generalised linear models. Travel-time was modelled using restricted cubic splines for each country and combined. Adjustments were made for key confounders. Results: Travel-time to key healthcare facilities influenced the diagnostic experience and outcomes of CRC patients from Scotland and Denmark to some extent differently. The longest travel-times to a specialised hospital appeared to afford the most rapid secondary care interval, whereas moderate travel-times to hospital (about 20−60 min) appeared to impact on later stage and greater one-year mortality in Scotland, but not in Denmark. A U-shaped association was seen between travel-time to the GP and one year-mortality. Conclusions: This is the first international data-linkage study to explore how different national geographies and health service structures may determine cancer outcomes. Future research should compare more countries and more cancer sites and evaluate the impact and implications of differences in national health service organisation.

KW - Colorectal neoplasms

KW - Diagnosis

KW - Mortality

KW - Neoplasm staging

KW - Primary health care

KW - Time-to-treatment

KW - Travel

UR - http://www.scopus.com/inward/record.url?scp=85113166287&partnerID=8YFLogxK

U2 - 10.1016/j.canep.2021.102004

DO - 10.1016/j.canep.2021.102004

M3 - Journal article

C2 - 34419802

AN - SCOPUS:85113166287

VL - 74

JO - Cancer Epidemiology

JF - Cancer Epidemiology

SN - 1877-7821

M1 - 102004

ER -