title: [Social and geographical determinants of cancer care management in France - colorectal cancer incidence in Calvados from 1997 to 2004].
abstract: BACKGROUND
  Numerous studies have underlined an important deprivation gap in survival in all industrialized countries, prognosis being constantly poorer for the most deprived patients. Beside clinical factors, the explanation of this gap in survival could be partly explained by the influence of socio-geographical environment on cancer care management. The aim of this retrospective population-based study was to investigate the influence of socio-geographical determinants on access to a reference care centre.
  
  
  METHODS
  The study population included all colorectal cancer patients with surgical treatment diagnosed between 1/01/1997 and 31/12/2004 in Calvados (n=2318). Individual clinical data were supplied by the Calvados registry of the gastrointestinal tumors. Beside geographical variables (distance to nearest cancer center), aggregate socioeconomic data were derived from the last exhaustive census organized by the national statistics institute (INSEE) in 1999. The Townsend deprivation index was used for this study. Due to the hierarchical structure of such variables, a multilevel logistic model was used (Level 1: Patients; Level 2: IRIS2000).
  
  
  RESULTS
  After adjustment on the individual variables, most remote patients were less frequently treated in a reference care center than those who were living near a reference care center (Odds Ratio adjust=0.20 [0.15-0.28], p-trend<0.001). Patients living in an IRIS2000 with high medical density were more likely to receive surgical treatment in a reference care centre (p-trend=0.05). Townsend Deprivation index was not associated with access to reference care center.
  
  
  CONCLUSIONS
  Access to a reference care center was strongly determined by the distance to nearest care center. Dissemination of clinical guidelines and improvement in treatment in non-reference care centers are crucial in ensuring equality in health care.
authors.affiliation: CHU de Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Jambon
authors.forename: O
authors.initials: O
authors.lastname: Dejardin
authors.forename: F
authors.initials: F
authors.lastname: Morlais
authors.forename: C
authors.initials: C
authors.lastname: Pornet
authors.forename: V
authors.initials: V
authors.lastname: Bouvier
authors.forename: G
authors.initials: G
authors.lastname: Launoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005602:France / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies