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Disparities in Receipt of Screening Tests for Cancer, Diabetes and High Cholesterol in Ontario, Canada: A Population-based Study Using Area-based Methods

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Abstract

OBJECTIVES: Few have compared socio-economic disparities in screening tests for cancer with recommended tests for other chronic diseases. We examined whether receipt of testing for colorectal, cervical and breast cancer, as well as diabetes and high cholesterol, differs by neighbourhood-level socio-economic and recent immigrant status.

METHODS: We conducted a population-based retrospective cohort study of patients identified as screen-eligible in 2009 living in Ontario, Canada. Postal codes were used to assign residents to a dissemination area (DA). Using Canadian census data, DAs were stratified by income quintile and proportion of recent immigrants. Prevalence of screening for cancer (colorectal, cervical, breast), diabetes, and high cholesterol, using administrative data, and prevalence ratios (least/most advantaged) were calculated.

RESULTS: The cohort comprised 7,652,592 people. Receipt of screening for colorectal cancer (women 61.6%; men 55.1%) and breast cancer (59.9%) were the lowest and diabetes (women 72.9%; men 61.4%) and high cholesterol (women 82.4%; men 70.3%) were the highest. We found disparities in the receipt of all tests, with the lowest uptake and largest disparities for cancer screening among those living in both low-income and high-immigration DAs: colorectal–women 48.6%; RR 0.77; 95% CI (0.74-0.79) and men 40.6%; RR 0.71 (0.68-0.74); cervical–52.0%; RR 0.80 (0.78-0.81) and breast—45.7%; RR 0.74 (0.72-0.77).

CONCLUSION: People living in low-income and high-immigration DAs had the lowest screening participation for all tests, although disparities were highest for cancer. An organized integrated chronic disease screening strategy leveraging the higher diabetes and high cholesterol screening participation may increase screening for cancer and other chronic diseases in never- and underscreened populations.

Résumé

OBJECTIFS: Peu d’études comparent les disparités socioéconomiques dans le recours aux tests de dépistage du cancer et aux tests recommandés pour dépister d’autres maladies chroniques. Nous avons cherché à déterminer si le recours aux tests de dépistage du cancer colorectal, du col utérin et du sein, ainsi que du diabète et de l’hypercholestérolémie, diffère selon le niveau socioéconomique du quartier et le statut d’immigrant récent.

MÉTHODE: Nous avons mené une étude de cohortes populationnelle rétrospective auprès de patients vivant en Ontario (Canada) identifiés comme étant admissibles au dépistage en 2009. Les codes postaux ont servi à affecter chaque résident à une aire de diffusion (AD). À l’aide des données du Recensement du Canada, les AD ont été stratifiées selon le quintile de revenu et la proportion d’immigrants récents. Nous avons calculé la prévalence du dépistage du cancer (colorectal, du col utérin, du sein), du diabète et de l’hypercholestérolémie à l’aide de données administratives, ainsi que les ratios de prévalence (moins/mieux nantis).

RÉSULTATS: La cohorte comptait 7 652 592 personnes. La participation au dépistage du cancer colorectal (femmes 61,6 %; hommes 55,1 %) et du cancer du sein (59,9 %) était la plus faible, et la participation au dépistage du diabète (femmes 72,9 %; hommes 61,4 %) et de l’hypercholestérolémie (femmes 82,4 %; hommes 70,3 %) était la plus élevée. Nous avons constaté des disparités dans le recours à tous les tests, la participation la plus faible et les plus grandes disparités dans le dépistage du cancer étant observés chez les résidents des AD à faible revenu et à forte immigration: cancer colorectal–femmes 48,6 %; RT 0,77; IC de 95 % (0,74–0,79) et hommes 40,6 %; RT 0,71 (0,68–0,74); cancer du col utérin–52,0 %; RT 0,80 (0,78–0,81) et cancer du sein–45,7 %; RT 0,74 (0,72–0,77).

CONCLUSIONS: Les résidents des AD à faible revenu et à forte immigration affichaient la plus faible participation au dépistage pour l’ensemble des tests, mais avec des disparités plus prononcées pour le dépistage du cancer. Une stratégie structurée et intégrée de dépistage des maladies chroniques misant sur la participation plus élevée au dépistage du diabète et de l’hypercholestérolémie pourrait accroître le dépistage du cancer et d’autres maladies chroniques dans les populations jamais ou insuffisamment dépistées.

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Authors and Affiliations

  1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Cornelia M. Borkhoff PhD, Refik Saskin MSc, Linda Rabeneck MD, MPH, FRCPC, Nancy N. Baxter MD, PhD, FRCSC, Ying Liu MSc, Jill Tinmouth MD, PhD, FRCPC & Lawrence F. Paszat MD, MS, FRCPC

  2. Women’s College Research Institute, Women’s College Hospital, Room 728 - 790 Bay Street, Toronto, ON, M5G 1N8, Canada

    Cornelia M. Borkhoff PhD

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Cornelia M. Borkhoff PhD, Refik Saskin MSc, Linda Rabeneck MD, MPH, FRCPC, Nancy N. Baxter MD, PhD, FRCSC, Jill Tinmouth MD, PhD, FRCPC & Lawrence F. Paszat MD, MS, FRCPC

  4. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Linda Rabeneck MD, MPH, FRCPC & Jill Tinmouth MD, PhD, FRCPC

  5. Cancer Care Ontario, Toronto, ON, Canada

    Linda Rabeneck MD, MPH, FRCPC

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Linda Rabeneck MD, MPH, FRCPC & Lawrence F. Paszat MD, MS, FRCPC

  7. Department of Surgery and Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Nancy N. Baxter MD, PhD, FRCSC

  8. Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Jill Tinmouth MD, PhD, FRCPC

Authors
  1. Cornelia M. Borkhoff PhD
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  2. Refik Saskin MSc
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  3. Linda Rabeneck MD, MPH, FRCPC
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  4. Nancy N. Baxter MD, PhD, FRCSC
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  5. Ying Liu MSc
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  6. Jill Tinmouth MD, PhD, FRCPC
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  7. Lawrence F. Paszat MD, MS, FRCPC
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Corresponding author

Correspondence to Cornelia M. Borkhoff PhD.

Additional information

Financial Support: Financial support for this study was provided in part by The Ontario Cancer Screening Research Network (PI Lawrence F. Paszat) and a grant from the Canadian Cancer Society Research Institute. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing and publishing the paper.

Conflict of Interest: None to declare.

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Borkhoff, C.M., Saskin, R., Rabeneck, L. et al. Disparities in Receipt of Screening Tests for Cancer, Diabetes and High Cholesterol in Ontario, Canada: A Population-based Study Using Area-based Methods. Can J Public Health 104, e284–e290 (2013). https://doi.org/10.17269/cjph.104.3699

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  • DOI: https://doi.org/10.17269/cjph.104.3699

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