Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_36_2952 - Disparities in Accessibility to Radiation Therapy in a High-Income Country: The Case of Canada

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Disparities in Accessibility to Radiation Therapy in a High-Income Country: The Case of Canada
J. Chan1,2, A. Polo2, M. Abdel-Wahab2, D. Hirata3, J. M. Bourque1, and E. Zubizarreta2; 1The Ottawa Hospital, Ottawa, ON, Canada, 2International Atomic Energy Agency, Vienna, Austria, 3Hiroshima University, Faculty of Medicine, Hiroshima, Japan

Purpose/Objective(s): Canada is a high-income country with universal healthcare. However, Canada’s large geographic area and small population density creates challenges in accessibility to oncologic treatment, such as radiotherapy. We sought to explore regional variations in cancer outcomes across Canada and the potential associated variables, including distance to nearest radiotherapy centre, sociodemographic factors, and the impact of any spatial relationships.

Materials/Methods: We conducted spatial autocorrelation using the global Moran’s I statistic to detect non-random spatial patterns in age standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions in Canada, from 2010 to 2012. Global ordinary least squares (OLS) regression and geographically-weighted regression (GWR) were then applied to examine relationships between distance to nearest radiotherapy facility, sociodemographic factors, and the observed spatial patterns.

Results: All-cancer MIRs by health region across Canada exhibited positive statistically significant global Moran’s I index values, with a tendency towards clustering (Moran’s I = .346, p = .001). Mapping of clusters showed one high-MIR cluster (range .45–.88) involving two of three Canadian territories (Nunavut and Northwest Territories) and the north of certain provinces (Manitoba, Ontario and Quebec). A second cluster of low-MIRs (range .40–.41) was observed in the southern region of British Columbia. In both regression models, health regions with longer Euclidean distance to nearest radiotherapy centre, higher rates of smoking and lower rates of food security were significantly associated with higher MIR (r2 = .70 with OLS and r2 = .74 with GWR).

Conclusion: Disparities in cancer outcomes exist in Canada and exhibit a north-south gradient, with poorer outcomes in the more northern regions. Differences in accessibility to radiotherapy may explain these regions’ poorer outcomes, along with other sociodemographic factors. Further work is required to better understand how best to improve access to radiotherapy in Canada for regions with poorer accessibility.

Author Disclosure: J. Chan: None. M. Abdel-Wahab: appropriateness criteria taskforce member;FRS boar; ACR & florida radiological society (FRS). Steering committee member; United Nations ute agency task force steering comm. D. Hirata: None. J. Bourque: None. E. Zubizarreta: None.

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