Travel times to health care and survival from cancers in Northern England.
The aim was to assess the effect of geographical accessibility on the stage of cancer at diagnosis and survival. Records of 117,097 cases of breast, colorectal, lung, ovary and prostate cancer diagnosed in Northern England between 1994 and 2002 were supplemented with estimates of travel times to the patients' general practitioners (GPs) and hospitals attended, together with measures of access to public transport. Logistic regression and Cox proportional hazards models were used, adjusting for age, sex, whether the first hospital visited was a cancer centre and deprivation of area of residence. Late stage at diagnosis was associated with increasing travel time to GP for breast and colorectal cancers and risk of death was associated with travel time to GP for prostate cancer. Travel times to hospital and other accessibility measures showed no consistent associations with stage at diagnosis or survival, so travel to GP was the only influential factor.
Jones
A P
AP
School of Environmental Sciences, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK.
Haynes
R
R
Sauerzapf
V
V
Crawford
S M
SM
Zhao
H
H
Forman
D
D
D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality; D015179:Colorectal Neoplasms / Q000401:mortality; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000401:mortality; D011471:Prostatic Neoplasms / Q000401:mortality; D012111:Residence Characteristics; D016019:Survival Analysis; D013997:Time Factors; D014195:Travel