title: Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference?
abstract: BACKGROUND
  The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance.
  
  
  METHODS
  The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis.
  
  
  RESULTS
  People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16-1.48) or with private health insurance (OR 1.27, 95% CI: 1.14-1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66-0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death.
  
  
  CONCLUSIONS
  The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better.
authors.affiliation: School of Population Health, University of Western Australia, Crawley, Western Australia, Australia. shall@dph.uwa.edu.au
authors.forename: Sonja E
authors.initials: SE
authors.lastname: Hall
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.forename: Cameron
authors.initials: C
authors.lastname: Platell
authors.forename: Harry
authors.initials: H
authors.lastname: Sheiner
authors.forename: Timothy
authors.initials: T
authors.lastname: Threlfall
authors.forename: James
authors.initials: J
authors.lastname: Semmens
mesh_terms: D000367:Age Factors; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012959:Socioeconomic Factors