title: Are there regional differences in gynecologic cancer outcomes in the context of a single-payer, publicly-funded health care system? A population-based study.
abstract: BACKGROUND
  Canada has a single-payer, publicly-funded health care system that provides comprehensive health care, and therefore significant disparities in health outcomes are not expected in our population. The objective of this study was to determine if differences exist in endometrial cancer outcomes across regions in Ontario.
  
  
  METHODS
  This was a population-based study of all endometrial (uterine) cancer cases diagnosed from 1996 to 2000 in Ontario and linked to various administrative databases. Univariate analyses examined trends in demographics (age, income, co-morbidities), treatment (surgical staging and adjuvant pelvic radiotherapy), and pathology (grade, histology, stage) across 14 geographic regions defined by local health integration networks (LHINs) in Ontario. Primary outcome was 5-year overall survival among LHINs, which were compared in a multilevel Cox regression model to account for clustering of patient data at the hospital level.
  
  
  RESULTS
  There were 3,875 evaluable cases with complete information on demographics, treatment, pathology, and outcomes. There was significant variation in patient demographics, treatment, and pathology across the 14 LHINs. Low income level and surgery at a low-volume, community hospital without gynecologic oncologists were not associated with a higher risk of death. There was a trend towards clustering of patients within hospitals. After adjustment for covariates, there was no significant difference in survival across LHINs.
  
  
  CONCLUSIONS
  In the context of a single-payer, publicly-funded health care system, we did not find significant regional differences in endometrial cancer outcomes.
authors.affiliation: Division of Gynecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver, BC. janice.kwon@vch.ca
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
authors.forename: Mark S
authors.initials: MS
authors.lastname: Carey
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.forename: Feng
authors.initials: F
authors.lastname: Qiu
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Paszat
mesh_terms: D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D009864:Ontario; D017063:Outcome Assessment, Health Care; D011634:Public Health; D012051:Reimbursement Mechanisms; D014594:Uterine Neoplasms / Q000145:classification / Q000532:radiotherapy* / Q000601:surgery*