title: Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran.
abstract: BACKGROUND
  Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization.
  
  
  METHODS
  All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant.
  
  
  RESULTS
  Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI.
  
  
  CONCLUSIONS
  We concluded that several factors contribute to disparity in healthcare utilization in the studied population.
authors.affiliation: Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Gholamreza
authors.initials: G
authors.lastname: Roshandel
authors.forename: Reza
authors.initials: R
authors.lastname: Majdzadeh
authors.forename: Abbasali
authors.initials: A
authors.lastname: Keshtkar
authors.forename: Kiarash
authors.initials: K
authors.lastname: Aramesh
authors.forename: Seyed Mehdi
authors.initials: SM
authors.lastname: Sedaghat
authors.forename: Shahryar
authors.initials: S
authors.lastname: Semnani
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012306:Risk; D012307:Risk Factors