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How to borrow ebooks and Audio Books with. Heggan Free Public Library. Apple, Android version 4. This surprising results - special regimes have, in theory, the most generous health care plan - are in line with the observation of the worst stage at diagnosis in this group, which suggest that screening and early detection programs are not properly working in special regime entities.
Regarding socioeconomic stratification, survival rates or cervical cancer were 7 and 14 percent-points higher in low and middle social strata, respectively, in comparison with the richest group. Incidence rates were lower in the richest group, and the relative low frequency of disease among the wealthiest part of the population may result in a lower awareness or lower participation rates in screening and early treatment programs for cervical cancer.
However, differences in clinical stage at diagnosis did not reach statistical significance - perhaps because number of cases in the high strata was very low see supplementary table.
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In this regard, Brookfield et al. Neither race, nor ethnicity, nor SES was an independent predictor of poorer outcome. Similarly, Niu et al. For lung cancer, 2. These results are contradictory with those reported in US 36 where uninsured and Medicaid patients had poorer survival than patients with private insurance. This pattern may be reflecting barriers to early diagnosis and treatment in this subgroup, which in Manizales is mostly composed by teachers, and army and police members.
However, this should be confirmed by studies with a larger number of patients. Survival proportions were around five percent-points lower in the lowest socioeconomic stratum in comparison with the most affluent group, which is consistent with figures reported by Ou et al Disparities in cancer survival related to the health system can be attributed to barriers and delays in obtaining diagnostic care, associated with more advanced stages at diagnosis.
In Colombia, practically all medical procedures require authorization from the insurer, which in many cases lead to substantial diagnostic and treatment delays and - consequently - to more advanced stages in diagnosis and poorer outcomes 38 , Therefore, many people turn to the out-of-pocket payment of some services to avoid delays, but people with low financial resources have no other avenues for access to timely diagnosis and treatment and are subject to the administrative procedures of their insurers. The population-based nature of this work minimizes selection biases in the estimates and serves as a tool for policy-makers to evaluate access and quality of care.
Although numbers of patients are relatively small due to the small population size of Manizales, estimates are sufficiently robust to discern general patterns. A major limitation of this study is the lack of relative or net survival estimations by HIR and SS due to lack of available data on population numbers and life-tables by those variables. The registry had no access to the cause of death, making it impossible to calculate cause-specific survival. For cancers with a very poor prognosis, this is not so problematic as most patients will die due to their cancer.
However, for cancers with a relatively good prognosis e. Considerable proportions of cases had unknown data about SS, specially for cervix, prostate and stomach cancers In addition, the percentage of cases with missing data for clinical staging at diagnosis was high for all cancers, except breast and cervical cancer: The number of cases was very low in some cancer sites and affected multivariate analysis. However, a recent paper showed that, even though DCO diagnosis is associated with low SS, exclusion or inclusion of DCO cases had no significant impact of hazard ratios for survival by socioeconomic variables Important inequities in cancer survival exist in Manizales related to health insurance and socioeconomic position.
Differences may be attributed to inequities in comorbidities, stage at diagnosis, or barriers to timely access to effective treatment suggested by differences observed between health insurance regimes. We would like to thank the Local Health Authority in Manizales for providing death data, and to the National Cancer Institute for the technical and financial support to this research.
To medical institutions in Manizales for their cooperation in data collection. This study was funded by the National Cancer Institute of Colombia and University of Caldas through inter-administrative contract number Hubo 77 casos DCO, que representaron el 5. Para los cinco tumores estudiados, 1, casos fueron finalmente analizados.
El tiempo medio de seguimiento fue de La supervivencia observada SO fue de Los riesgos de morir Hazard Ratios estimados para RAS estuvieron en concordancia con los reportados por otros estudios 1. La magnitud de estas disparidades es similar a la encontrada en EE.
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Investigadores locales han resaltado que la universalidad en nuestro sistema de salud no ha sido alcanzada y que hay un estancamiento en materia de acceso a los servicios y en la igualdad Al respecto, Brookfield et al. Similarmente, Niu et al. Estos resultados son contradictorios con los reportados en EE. National Center for Biotechnology Information , U. Journal List Colomb Med Cali v. Published online Mar Find articles by Nelson Enrique Arias-Ortiz. Author information Article notes Copyright and License information Disclaimer.
Sede Versalles Universidad de Caldas. None of the authors have any conflicts of interest to be reported.
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The funding had no influence in study design; in the collection, analysis and interpretation of data; in the writing of the report; neither in the decision to submit the article for publication. This article is distributed under the terms of the Creative Commons Attribution License http: Introduction Socio-economic differences in cancer survival have been well documented in the last two decades 1. Materials and Methods Type of study Exploratory population-based cohort study.
Clinical and demographic characteristics Information on histological subtype coded according to the International Classification of Diseases for Oncolgy, 3 rd revision -ICDO was available for Socioeconomic indicators Variables for socioeconomic position and health insurance were defined following categories previously used for a Colombian population by de Vries et al 8. Statistical analysis Observed survival proportions at different times were obtained using Kaplan-Meier analyses, stratifying analyses by HIR and SS, age, sex, histological subtype and, for breast and cervical cancer only, clinical stage at diagnosis.
Results Patient and tumour characteristics for all 1, incident cases are shown in Supplementary Table 1S. Table 1 Survival estimations by cancer site and prognostic factors. Open in a separate window. Observed survival by health insurance regime and cancer site. Observed survival by social strata and by cancer site. Survival proportion by clinical stage at diagnosis for breast cancer based on cases with known clinical stage and cervix uteri cancer based on 95 cases.
Table 2 Proportional risks Cox survival models by cancer site. Amazon Drive Cloud storage from Amazon. Alexa Actionable Analytics for the Web. AmazonGlobal Ship Orders Internationally. Amazon Inspire Digital Educational Resources. Amazon Rapids Fun stories for kids on the go.
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