title: Social position and referral to rehabilitation among cancer patients.
abstract: OBJECTIVE
  In Denmark, most healthcare services, including cancer treatment and rehabilitation, are offered free of charge by referral from a treating physician; thus, social equality should be expected. In a population-based cohort study of registry-based data, we examined the association between socioeconomic position, measured as educational level, and referral to rehabilitation services among cancer patients.
  
  
  METHODS
  Through the Danish Cancer Registry, we identified all people resident in the Municipality of Copenhagen with cancer diagnosed in 2007-2012. Information on all rehabilitation referrals was retrieved from the Municipal Centre for Cancer Rehabilitation for 2009-2012. Information on demographic and socioeconomic characteristics was obtained from national Danish registers. The Cox proportional hazards model was used to investigate associations between educational level and referral to rehabilitation with adjustment for sex, age, diagnosis, disposable income, cohabitation status and number of children living at home at the time of diagnosis.
  
  
  RESULTS
  A primary cancer was diagnosed in 13 840 people, of whom 2148 (16%) were referred to rehabilitation services during follow-up. In the fully adjusted model, we found education to be a predictor of referral, with a hazard ratio of 1.33 (95% CI 1.19-1.49) for patients with long education and a hazard ratio of 1.15 (95% CI 1.03-1.29) for patients with medium education as compared with patients with short education.
  
  
  CONCLUSIONS
  Our findings suggest that, even after differences in demographics and cancer characteristics are accounted for, referral to rehabilitation services is not equally distributed by social group. Higher educational level is associated with a higher probability of referral to rehabilitation services.
authors.affiliation: Danish Cancer Society Research Center, Survivorship Unit , Copenhagen , Denmark.
authors.forename: Ida R
authors.initials: IR
authors.lastname: Moustsen
authors.forename: Signe B
authors.initials: SB
authors.lastname: Larsen
authors.forename: Jette
authors.initials: J
authors.lastname: Vibe-Petersen
authors.forename: Karen
authors.initials: K
authors.lastname: Trier
authors.forename: Pernille E
authors.initials: PE
authors.lastname: Bidstrup
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Andersen
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Susanne O
authors.initials: SO
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003718:Denmark; D004522:Educational Status; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012923:Social Class