Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_36_2953 - Access to Radiation Therapy Among Indigenous Populations in Canada

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

Access to Radiation Therapy Among Indigenous Populations in 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): Indigenous populations in Canada exhibit higher rates of cancer mortality compared to non-indigenous populations. Radiotherapy (RT) is an important component of cancer treatment, but little information exists on accessibility to RT among this population. We sought to explore disparities in accessibility to RT among indigenous populations in Canada, and its impact on cancer outcomes.

Materials/Methods: We initially conducted univariate and multivariate analyses across health regions (HR) in Canada, using age-standardized all-cancer mortality-to-incidence ratios (MIRs) from 2010–2012 as the dependent variable, and proportion of self-identified Aboriginals, shortest Euclidean (straight-line) distance to nearest RT facility, and other sociodemographic factors as independent variables. High multicollinearity was observed between the proportion of Aboriginals variable and other sociodemographic factors; therefore, a multiple linear regression model was not possible. We stratified our two independent variables of interest (proportion of self-identified Aboriginals, and distance to RT center) using an exploratory recursive partitioning approach, and compared the resulting groups with respect to their impact on MIR.

Results: HRs with <23% versus ≥23% Aboriginals had significantly lower MIR (0.42 vs. 0.53, respectively; p<.01) and shorter distance to nearest RT center (121km vs. 799km, respectively; p<.01). In a significant one-way ANOVA considering both distance and proportion of Aboriginals (F=33.07, p<.01), HRs with ≥23% Aboriginals had higher MIR compared to those with <23%, regardless of whether they were located less or greater than 37km away (both p<.01), and HRs with <23% Aboriginals located ≥37km from nearest RT center had higher MIRs versus those <37km away (p<.01). A sub-analysis on HRs located 150–750km from nearest RT center revealed that HRs with ≥23% Aboriginals had higher MIR versus those with <23% Aboriginals (p=.03), despite no significant difference in distance to nearest RT center (p=.43).

Conclusion: Regions inhabited by a larger proportion of indigenous populations are located further away from the nearest RT center, but distance does not completely explain these regions’ poorer oncologic outcomes. Further exploration and identification of other contributing factors to this population’s high MIR is required.

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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