Introduction
Methods
Study population and data sources
Study variables
Health outcomes
Resource use
Care process: lead times
Patient characteristics
Statistical analysis
Results
Patient characteristics
Variable | Category | No. patients Stockholm | % | No. patients total | % |
---|---|---|---|---|---|
Number of patients | 845 | 1149 | |||
Age (average) | 57.6 | 56.6 | |||
Age category | 18–39 | 90 (845) | 10.7 | 141 (1149) | 12.3 |
40–59 | 332 (845) | 39.3 | 456 (1149) | 39.7 | |
60–69 | 284 (845) | 33.6 | 379 (1149) | 33.0 | |
70– | 139 (845) | 16.5 | 173 (1149) | 15.1 | |
Year of diagnosis | 01/04 | 223 (845) | 26.4 | 268 (1149) | 23.3 |
05/07 | 171 (845) | 20.2 | 222 (1149) | 19.3 | |
08/10 | 224 (845) | 26.5 | 337 (1149) | 29.3 | |
11/13 | 227(845) | 26.9 | 322 (1149) | 28.0 | |
Sex (male) | 513 (845) | 60.7 | 684 (1149) | 59.5 | |
Comorbidity (%)** | 375 (845) | 44.4 | |||
Education level | Elementary | 153 (818) | 18.7 | 210 (1118) | 18.8 |
High school diploma | 337 (818) | 41.2 | 472 (1118) | 42.2 | |
University degree | 328 (818) | 40.1 | 445 (1118) | 39.8 | |
Disposable income | Low | 306 (818) | 37.4 | 430 (1118) | 38.5 |
Intermediate | 337 (818) | 41.2 | 478 (1118) | 42.8 | |
High | 175 (818) | 21.4 | 220 (1118) | 19.7 | |
Country of birth | Born in Sweden | 687 (841) | 81.75 | 977 (1149) | 85.0 |
Born in Europe (not Sweden) | 105 (841) | 12.5 | 125 (1149) | 10.9 | |
Born outside Europe | 49 (841) | 5.8 | 52 (1149) | 4.5 | |
Grade IV | 725 (845) | 85.8 | 968 (1149) | 84.3 |
Survival
Cox proportional hazards | Survival (univariable) | Survival (multivariable) | ||
---|---|---|---|---|
Haz. ratio (95% CI) | p value | Haz. ratio (95% CI) | p value | |
Age category (ref: 18–39) | ||||
40–59 | 2.29 (1.83–2.87) | < 0.001 | 2.15 (1.59–2.90) | < 0.001 |
60–69 | 3.08 (2.45–3.88) | < 0.001 | 3.13 (2.28–4.29) | < 0.001 |
70– | 4.68 (3.61–6.07) | < 0.001 | 4.25 (2.99–6.02) | < 0.001 |
Year of diagnosis (ref: 01/04) | ||||
05/07 | 0.98 (0.81–1.19) | 0.853 | 0.91 (0.72–1.14) | 0.399 |
08/10 | 1.08 (0.91–1.28) | 0.402 | 0.92 (0.74–1.14) | 0.450 |
11/13 | 0.95 (0.80–1.15) | 0.617 | 0.84 (0.67–1.06) | 0.145 |
Sex | ||||
Male | 1.12 (0.99–1.27) | 0.074 | 1.24 (1.05–1.46) |
0.010
|
Comorbidity* | ||||
Comorbid | 1.33 (1.15–1.54) | < 0.001 | 1.13 (0.97–1.32) | 0.127 |
Educational level (ref: elementary) | ||||
High school diploma | 0.88 (0.74–1.05) | 0.166 | 0.96 (0.78–1.19) | 0.739 |
University degree | 0.83 (0.70–0.99) |
0.036
| 0.99 (0.79–1.24) | 0.937 |
Income level (ref: low) | ||||
Medium | 1.04 (0.91–1.20) | 0.563 | 0.89 (0.74–1.06) | 0.191 |
High | 0.97 (0.81–1.16) | 0.749 | 0.76 (0.60–0.97) |
0.024
|
Country of birth (ref: Sweden) | ||||
Born in Europe (not Sweden) | 1.13 (0.93–1.39) | 0.219 | 1.23 (0.98–1.55) | 0.072 |
Born outside Europe | 0.81 (0.59–1.11) | 0.192 | 0.94 (0.65–1.34) | 0.722 |
Grade IV (ref: grade III) | ||||
Grade IV | 2.00 (1.58–2.53) | < 0.001 | 1.57 (1.23–2.02) | < 0.001 |
Resource use
Outpatient visits the year before diagnosis
Negative binomial regression | Preoperative visits (univariable) | Preoperative visits (multivariable) | Postoperative visits (univariable) | Postoperative visits (multivariable) | ||||
---|---|---|---|---|---|---|---|---|
IRR | p value | IRR | p value | IRR | p value | IRR | p value | |
Age category (ref: 18–39) | ||||||||
40–59 | 1.53 (1.15–2.05) |
0.004
| 1.40 (1.06–1.84) |
0.016
| 1.08 (0.86–1.36) | 0.487 | 1.03 (0.81–1.31) | 0.814 |
60–69 | 2.31 (1.72–3.09) | < 0.001 | 1.82 (1.37–2.41) | < 0.001 | 1.27 (1.00-1.62) | 0.052 | 1.17 (0.89–1.52) | 0.256 |
70– | 3.12 (2.25–4.32) | < 0.001 | 2.12 (1.52–2.96) | < 0.001 | 1.13 (0.80–1.58) | 0.493 | 1.07 (0.74–1.54) | 0.718 |
Year of diagnosis (ref: 01/04) | ||||||||
05/07 | 1.04 (0.82–1.33) | 0.748 | 0.93 (0.75–1.17) | 0.556 | 1.28 (1.02–1.61) |
0.035
| 1.28 (1.00-1.63) |
0.049
|
08/10 | 0.85 (0.68–1.07) | 0.165 | 0.77 (0.62–0.95) |
0.015
| 1.25 (1.00-1.55) | 0.051 | 1.27 (1.00-1.61) |
0.046
|
11/13 | 0.94 (0.75–1.18) | 0.584 | 0.74 (0.60–0.92) |
0.007
| 1.46 (1.17–1.82) |
0.001
| 1.53 (1.20–1.95) |
0.001
|
Sex | ||||||||
Male | 2.67 (2.30–3.10) | < 0.001 | 0.99 (0.84–1.15) | 0.86 | 1.08 (0.92–1.27) | 0.361 | 1.29 (1.08–1.53) |
0.004
|
Comorbidity | 0.80 (0.64-1.00) |
0.046
| 2.41 (2.05–2.84) | < 0.001 | 0.99 (0.78–1.25) | 0.906 | 1.02 (0.86–1.20) | 0.846 |
Educational level (ref: elementary) | ||||||||
High school diploma | 0.57 (0.46–0.72) | < 0.001 | 0.96 (0.78–1.19) | 0.708 | 0.99 (0.79–1.26) | 0.964 | 1.01 (0.79–1.28) | 0.964 |
University degree | 0.76 (0.63–0.92) |
0.004
| 0.83 (0.67–1.04) | 0.114 | 1.00 (0.83–1.20) | 0.968 | 1.06 (0.83–1.36) | 0.657 |
Income level (ref: low) | ||||||||
Medium | 0.78 (0.64–0.93) |
0.007
| 0.86 (0.72–1.03) | 0.097 | 1.02 (0.85–1.23) | 0.831 | 0.93 (0.76–1.12) | 0.437 |
High | 0.64 (0.51–0.80) | < 0.001 | 0.81 (0.65–1.02) | 0.071 | 1.03 (0.82–1.29) | 0.803 | 0.83 (0.65–1.06) | 0.136 |
Country of birth (ref:Sweden) | ||||||||
Born in Europe (not Sweden) | 1.35 (1.06–1.73) |
0.015
| 1.25 (0.99–1.58) | 0.065 | 1.28 (0.98–1.67) | 0.069 | 1.40 (1.07–1.83) |
0.014
|
Born outside Europe | 1.02 (0.72–1.43) | 0.93 | 1.08 (0.77–1.53) | 0.647 | 0.95 (0.68–1.34) | 0.77 | 0.93 (0.64–1.34) | 0.681 |
Grade IV (ref: grade III) | ||||||||
Grade IV | 0.00 (0.00–0.00) | 0.078 | 1.08 (0.86–1.35) | 0.516 | 1.22 (0.99–1.51) | 0.067 | 1.10 (0.88–1.39) | 0.399 |
Outpatient visits the year after diagnosis
Inpatient care the year before diagnosis
Negative binomial regression | Preoperative days (univariable) | Preoperative days (multivariable) | Postoperative days (univariable) | Postoperative days (multivariable) | ||||
---|---|---|---|---|---|---|---|---|
IRR | p value | IRR | p value | IRR | p value | IRR | p value | |
Age category (ref: 18–39) | ||||||||
40–59 | 1.36 (0.90–2.05) | 0.142 | 1.62 (1.13–2.31) |
0.009
| 1.96 (1.49–2.59) | < 0.001 | 2.04 (1.52–2.74) | < 0.001 |
60–69 | 1.75 (1.16–2.66) |
0.008
| 1.91 (1.31–2.79) |
0.001
| 2.53 (1.89–3.40) | < 0.001 | 2.40 (1.72–3.35) | < 0.001 |
70– | 2.57 (1.61–4.11) | < 0.001 | 4.79 (3.07–7.49) | < 0.001 | 1.65 (1.09–2.48) |
0.017
| 1.64 (1.04–2.59) |
0.033
|
Year of diagnosis (ref: 01/04) | ||||||||
05/07 | 0.74 (0.55–1.01) | 0.06 | 0.69 (0.51–0.92) |
0.011
| 1.27 (0.95–1.69) | 0.101 | 1.33 (0.99–1.80) | 0.06 |
08/10 | 0.25 (0.19–0.34) | < 0.001 | 0.18 (0.13–0.24) | < 0.001 | 1.38 (1.05–1.81) |
0.022
| 1.27 (0.96–1.68) | 0.089 |
11/13 | 0.25 (0.19–0.34) | < 0.001 | 0.14 (0.10–0.19) | < 0.001 | 1.04 (0.79–1.36) | 0.795 | 1.06 (0.80–1.42) | 0.674 |
Sex | ||||||||
Male | 0.93 (0.74–1.17) | 0.528 | 0.91 (0.74–1.13) | 0.399 | 0.95 (0.78–1.16) | 0.61 | 0.93 (0.76–1.14) | 0.487 |
Comorbidity | 1.72 (1.37–2.16) | < 0.001 | 1.67 (1.34–2.08) | < 0.001 | 1.28 (1.05–1.56) |
0.015
| 1.07 (0.86–1.33) | 0.528 |
Educational level (ref: elementary) | ||||||||
High school diploma | 0.71 (0.52–0.98) |
0.039
| 0.78 (0.58–1.05) | 0.101 | 1.02 (0.76–1.36) | 0.919 | 1.04 (0.78–1.40) | 0.785 |
University degree | 0.55 (0.40–0.77) | < 0.001 | 0.84 (0.62–1.15) | 0.277 | 1.02 (0.76–1.36) | 0.901 | 1.09 (0.80–1.47) | 0.594 |
Income level (ref: low) | ||||||||
Medium | 0.84 (0.65–1.09) | 0.192 | 0.91 (0.72–1.16) | 0.451 | 1.16 (0.93–1.46) | 0.181 | 1.10 (0.87–1.37) | 0.433 |
High | 0.38 (0.28–0.51) | < 0.001 | 0.74 (0.54–1.02) | 0.068 | 1.00 (0.77–1.31) | 0.993 | 0.91 (0.68–1.22) | 0.535 |
Country of birth (ref: Sweden) | ||||||||
Born in Europe (not Sweden) | 0.97 (0.68–1.38) | 0.868 | 1.13 (0.82–1.54) | 0.463 | 1.00 (0.73–1.38) | 0.994 | 1.11 (0.81–1.53) | 0.505 |
Born outside Europe | 0.90 (0.55–1.46) | 0.673 | 1.10 (0.68–1.79) | 0.690 | 0.84 (0.56–1.27) | 0.406 | 0.82 (0.53–1.28) | 0.376 |
Grade IV (ref: grade III) | ||||||||
Grade IV | 0.94 (0.68–1.30) | 0.705 | 1.06 (0.78–1.44) | 0.709 | 1.41 (1.09–1.83) |
0.009
| 1.21 (0.92–1.59) | 0.172 |
Inpatient care the year after diagnosis
Lead times
Lead times from diagnosis to surgery
Negative binomial regression | From diagnosis to surgery (univariate) | From diagnosis to surgery (multivariate) | From surgery to start of non-surgical cancer treatment (univariate) | From surgery to start of non-surgical cancer treatment (multivariate) | ||||
---|---|---|---|---|---|---|---|---|
IRR (CI) | p value | IRR (CI) | p value | IRR (CI) | p value | IRR (CI) | p value | |
Age category (ref: 18–39) | ||||||||
40–59 | 0.59 (0.44–0.81) |
0.001
| 1.13 (0.82–1.55) | 0.455 | 0.42 (0.33–0.52) |
0.000
| 0.67 (0.53–0.86) |
0.002
|
60–69 | 0.55 (0.40–0.75) |
0.000
| 1.30 (0.94–1.82) | 0.117 | 0.40 (0.32–0.50) |
0.000
| 0.68 (0.52–0.87) |
0.003
|
70– | 0.82 (0.57–1.20) | 0.306 | 1.64 (1.10–2.45) |
0.015
| 0.73 (0.52–1.02) | 0.063 | 1.21 (0.84–1.75) | 0.306 |
Year of diagnosis (ref: 01/04) | ||||||||
05/07 | 1.57 (1.03–2.38) |
0.035
| 0.91 (0.61–1.35) | 0.635 | 0.43 (0.29–0.62) |
0.000
| 0.64 (0.42–0.98) |
0.038
|
08/10 | 1.40 (0.93–2.10) | 0.105 | 1.36 (0.92–2.01) | 0.127 | 0.26 (0.18–0.37) |
0.000
| 0.42 (0.27–0.63) |
0.000
|
11/13 | 0.91 (0.61–1.37) | 0.651 | 0.97 (0.65–1.43) | 0.870 | 0.29 (0.20–0.42) |
0.000
| 0.40 (0.26–0.61) |
0.000
|
Sex | ||||||||
Male | 0.83 (0.69-1.00) |
0.049
| 0.91 (0.76–1.08) | 0.286 | 1.25 (1.08–1.46) |
0.003
| 1.01 (0.87–1.18) | 0.863 |
Comorbidity* | 1.57 (1.31–1.89) |
0.000
| 1.53 (1.28–1.83) |
0.000
| 0.81 (0.70–0.95) |
0.010
| 0.94 (0.81–1.10) | 0.460 |
Educational level (ref: elementary) | ||||||||
High school diploma | 1.00 (0.78–1.29) | 0.997 | 1.11 (0.87–1.41) | 0.409 | 1.19 (0.96–1.48) | 0.114 | 1.06 (0.86–1.31) | 0.588 |
University degree | 0.74 (0.57–0.95) |
0.018
| 1.02 (0.79–1.31) | 0.879 | 1.32 (1.07–1.64) |
0.011
| 0.98 (0.78–1.22) | 0.843 |
Income level (ref: low) | ||||||||
Medium | 1.30 (1.06–1.60) |
0.010
| 1.04 (0.86–1.27) | 0.669 | 0.68 (0.57–0.82) |
0.000
| 0.87 (0.73–1.04) | 0.122 |
High | 0.83 (0.66–1.05) | 0.116 | 0.88 (0.69–1.11) | 0.269 | 0.93 (0.77–1.13) | 0.467 | 1.10 (0.90–1.34) | 0.355 |
Country of birth (ref: Sweden) | ||||||||
Born in Europe (not Sweden) | 1.08 (0.82–1.41) |
0.000
| 0.70 (0.55–0.91) |
0.006
| 0.80 (0.63–1.02) | 0.077 | 0.94 (0.76–1.16) | 0.565 |
Born outside Europe | 3.43 (2.41–4.89) |
0.000
| 2.79 (1.91–4.09) |
0.000
| 0.78 (0.56–1.09) | 0.148 | 0.70 (0.50–0.97) |
0.030
|
Grade IV (ref: grade III) | ||||||||
Grade IV | 0.37 (0.29–0.49) |
0.000
| 0.48 (0.36–0.63) |
0.000
| 0.50 (0.40–0.63) | 0.077 | 0.70 (0.55–0.89) | 0.003 |