title: Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study.
abstract: OBJECTIVE
  In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients' clinical characteristics.
  
  
  METHODS
  Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 10(5) inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner.
  
  
  RESULTS
  Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5-15.7) versus 24.7, (95CI: 23.5-26.0)] and decreased as the distance to the general practitioner increased [27.0, (95CI: 25.5-28.4) versus 13.7, (95CI: 12.1-15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR = 2.28, 95CI: 0.97-5.39, P = 0.059).
  
  
  CONCLUSIONS
  A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.
authors.affiliation: Hepatology and Intensive Care unit, Besançon University Hospital Center, 1 Boulevard Fleming, 25030 Besançon cedex, France. elisabeth.monnet@univ-fcomte.fr
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Monnet
authors.forename: Estelle
authors.initials: E
authors.lastname: Collin-Naudet
authors.forename: Solange
authors.initials: S
authors.lastname: Bresson-Hadni
authors.forename: Anne
authors.initials: A
authors.lastname: Minello
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino
authors.forename: Didier
authors.initials: D
authors.lastname: Carel
authors.forename: Valérie
authors.initials: V
authors.lastname: Jooste
authors.forename: Alice
authors.initials: A
authors.lastname: Gagnaire
authors.forename: Philippe
authors.initials: P
authors.lastname: Evrard
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Obert-Clerc
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Miguet
authors.forename: Patrick
authors.initials: P
authors.lastname: Hillon
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006526:Hepatitis C / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012111:Residence Characteristics / Q000145:classification*; D012189:Retrospective Studies; D012424:Rural Population; D014505:Urban Population