title: The influence of geographical access to health care and material deprivation on colorectal cancer survival: evidence from France and England.
abstract: This article investigates the influence of distance to health care and material deprivation on cancer survival for patients diagnosed with a colorectal cancer between 1997 and 2004 in France and England. This population-based study included all cases of colorectal cancer diagnosed between 1997 and 2004 in 3 cancer registries in France and 1 cancer registry in England (N=40,613). After adjustment for material deprivation, travel times in England were no longer significantly associated with survival. In France patients living between 20 and 90min from the nearest cancer unit tended to have a poorer survival, although this was not statistically significant. In England, the better prognosis observed for remote patients can be explained by associations with material deprivation; distance to health services alone did not affect survival whilst material deprivation level had a major influence, with lower survival for patients living in deprived areas. Increases in travel times to health services in France were associated with poorer survival rates. The pattern of this influence seems to follow an inverse U distribution, i.e. maximal for average travel times.
authors.affiliation: University Hospital of Caen, U1086 INSERM UCBN "Cancers & Preventions", France. Electronic address: olivier.dejardin@unicaen.fr.
authors.forename: O
authors.initials: O
authors.lastname: Dejardin
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: A P
authors.initials: AP
authors.lastname: Jones
authors.affiliation: London School of Hygiene and Tropical Medicine (LSHTM), Cancer Survival Group, London, UK.
authors.forename: B
authors.initials: B
authors.lastname: Rachet
authors.affiliation: Leeds Institute of Cancer and Pathology, University of Leeds, UK.
authors.forename: E
authors.initials: E
authors.lastname: Morris
authors.affiliation: University Hospital of Caen, U1086 INSERM UCBN "Cancers & Preventions", France.
authors.forename: V
authors.initials: V
authors.lastname: Bouvier
authors.affiliation: Digestive Cancer Registry of Burgundy, CHU Dijon, INSERM U866, Université de Bourgogne, Dijon, F-21079, France.
authors.forename: V
authors.initials: V
authors.lastname: Jooste
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: E
authors.initials: E
authors.lastname: Coombes
authors.affiliation: Leeds Institute of Cancer and Pathology, University of Leeds, UK; International Agency for Research on Cancer (IARC), Cancer Information, Lyon France.
authors.forename: D
authors.initials: D
authors.lastname: Forman
authors.affiliation: Digestive Cancer Registry of Burgundy, CHU Dijon, INSERM U866, Université de Bourgogne, Dijon, F-21079, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Bouvier
authors.affiliation: University Hospital of Caen, U1086 INSERM UCBN "Cancers & Preventions", France.
authors.forename: G
authors.initials: G
authors.lastname: Launoy
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology; D004739:England; D005260:Female; D005602:France; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D013534:Survival; D014195:Travel
keywords: Colorectalcancer; Health care accessibility; Survival; Travel times