title: Accessibility as a major determinant of radiotherapy underutilization: a population based study.
abstract: OBJECTIVE
  A survey was conducted of radiotherapy (RT) resources and utilization in a northwestern Italian Region in order to assess geographical variations in radiotherapy utilization rates, and the effects of infrastructure supply on accessibility.
  
  
  METHODS
  The survey was conducted by analysing standardized utilization rates based on administrative records. The data were analysed at both Regional and Local Health Unit (LHU) level.
  
  
  RESULTS
  Wide variation was found among LHUs RT utilization rates--the sex- and age-standardized rates varied from 1.8/1000 inhabitants to more than 3/1000 inhabitants. Patients resident in LHUs with no RT service showed a lower probability of accessing RT (standardized rate ratio (SRR), 0.82; 95%IC, 0.80-0.85). The utilization rate decreased in relation to the distance between a patient's residence and the nearest RT service; the reduction was greater for patients > or =70 years of age.
  
  
  CONCLUSIONS
  The wide geographic variation implies lack of equity in access to services. Utilization levels decreased significantly with increasing distance from the nearest RT service, distance being a barrier to access particularly for older persons. The heterogeneous distribution of services on the Regional territory seems a relevant explanation of differences in utilization rates.
authors.affiliation: Unit of Cancer Epidemiology, Ospedale S. Giovanni Battista, CPO-Piemonte, University of Turin, Italy. evapagano@yahoo.com
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Daniela
authors.initials: D
authors.lastname: Di Cuonzo
authors.forename: Cristina
authors.initials: C
authors.lastname: Bona
authors.forename: Ileana
authors.initials: I
authors.lastname: Baldi
authors.forename: Pietro
authors.initials: P
authors.lastname: Gabriele
authors.forename: Umberto
authors.initials: U
authors.lastname: Ricardi
authors.forename: Paolo
authors.initials: P
authors.lastname: Rotta
authors.forename: Oscar
authors.initials: O
authors.lastname: Bertetto
authors.forename: Silvana
authors.initials: S
authors.lastname: Appiano
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Nereo
authors.initials: N
authors.lastname: Segnan
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
mesh_terms: D018672:Community Health Planning; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007558:Italy; D020380:Needs Assessment; D011878:Radiotherapy / Q000706:statistics & numerical data*