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Objective: To analyze differences in survival of breast, cervical, lung, prostate and stomach cancer by health insurance regime (HIR) and socioeconomic position (SEP) in an intermediate city in a middle-income country.

Methods: All patients with breast, cervix uteri, lung, prostate and stomach cancer  diagnosed between 2003 and 2007 and characterized by the Manizales population-based Cancer Registry (MCR) were included and followed up to a maximum of 5 years for identifying deaths. Survival probabilities estimated by HIR were defined according to the type of affiliation at the date of diagnosis, and by socioeconomic stratification of residence (SS) as indicator of SEP, stratifying for other prognostic factors using Kaplan-Meier methods. Cox proportional hazard models were fitted for multivariate analysis.

Results: A total of 1,384 cases and 700 deaths were analyzed. Five-year observed survival  was 71.0% (95% IC: 66.1-75.3) for breast, 51.4% (95% IC: 44.6-57.9) for cervix, 15.4% (95% IC: 10.7-20.8) for lung, 71.1% (95% IC: 65.3-76.1) for prostate and 23.8% (95% IC: 19.3-28.6) for stomach. Statistically significant differences in survival by HIR were observed for breast, lung, prostate, and stomach - with poorer survival for the subsidized and uninsured patients. Differences by SS were observed for lung and prostate. Differences in survival by HIR were independent of SS, and viceversa.

Conclusions: Important inequities in cancer survival exist related to HIR and SEP. Possible explanations include underlying comorbidities, late stage at diagnosis, or barriers to timely and effective treatment.

 

Nelson Enrique Arias-Ortiz, Universidad de Caldas

Profesor Auxiliar, Departamento de Salud Publica, Universidad de Caldas.

Doctor en Salud Pública, Universidad de Chile

Esther De Vries, Universidad Javeriana, Bogotá, Colombia.

Associate Professor, Department of Clinical Epidemiology and Biostatistics,
Arias-Ortiz, N. E., & De Vries, E. (2024). Health inequities and cancer survival in Manizales, Colombia: a population-based study. Colombia Medica, 49(1), 63–72. https://doi.org/10.25100/cm.v49i1.3629 (Original work published March 31, 2018)

Woods L, Rachet P, Coleman M. Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol. 2006; 45(Suppl 8): 15-9.

Booth CM, Li G, Zhang-Salomons J, Mackillop WJ. The impact of socioeconomic status on stage of cancer at diagnosis and survival: A population-based study in Ontario, Canada. Cancer. 2010;116(17):4160-7.

Eaker S, Halmin M, Bellocco R, Bergkvist L, Ahlgren J, Holmberg L, et al. Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden). Int J Cancer. 2009;124(1):180-7.

Newmann SJ, Garner EO. Social inequities along the cervical cancer continuum: A structured review. Cancer Causes Control. 2005;16(1):63-70.

Berglund A, Holmberg L, Tishelman C, Wagenius G, Eaker S, Lambe M. Social inequalities in non-small cell lung cancer management and survival: a population-based study in central Sweden. Thorax. 2010;65(4):327-33.

Klein J, von dem Knesebeck O. Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors. Soc Sci Med. 2015;(142):9-18.

Siemerink EJM, Hospers GAP, Mulder NH, Siesling S, van der Aa MA. Disparities in survival of stomach cancer among different socioeconomic groups in North-East Netherlands. Cancer Epidemiol. 2011;35(5):413-6.

de Vries E, Uribe C, Pardo C, Lemmens V, van de Poel E, Forman D. Gastric cancer survival and affiliation to health insurance in a middle-income setting. Cancer Epidemiol. 2015;39(1):91-6.

Ginsburg O, Bray F, Coleman MP, Vanderpuye V, Eniu A, Kotha SR, et al. The global burden of women’s cancers: a grand challenge in global health. Lancet. 2017; 389(10071):847-60.

Congreso de la República. Ley 100 de 1993, Por la cual se crea el sistema de seguridad social integral y se dictan otras disposiciones. Diario Oficial No. 41.148 de 23 de diciembre de 1993: Bogotá, D. C.; 1993.

Así vamos en Salud. Indicadores de aseguramiento [Internet]. Así vamos en salud. Bogotá; 2017. Cited: 2017 Sep 15. Available from: https://www.asivamosensalud.org/indicadores/aseguramiento/aseguramiento-georeferenciado.

Valenzuela S. Buscan remedio a modelo de salud de los maestros. El Colombiano: Medellín; 2017.

Redacción El Tiempo. Revolcón en el modelo de salud de las FFMM y de Policía. El Tiempo: Bogotá, D. C.; 2016.

Congreso de la República de Colombia. Ley 1438 del 19 de enero de 2011. Por medio de la cual se reforma el Sistema General de Seguridad Social en Salud y se dictan otras disposiciones. Diario Oficial 47957 de Enero 19 de 2011. Colombia. Available from: http://www.alcaldiabogota.gov.co/sisjur/normas/Norma1.jsp?i=41355.

Congreso de la República de Colombia. Ley estatutaria No. 1751 Por medio de la cual se regula el derecho fundamental a la salud y se dictan otras disposiciones. Diario Oficial No. 49427 del 16 de febrero de 2015. Available

from: https://www.minsalud.gov.co/Normatividad_Nuevo/Ley%201751%20de%202015.pdf

Arroyave I, Cardona D, Burdorf A, Avendano M. The impact of increasing health insurance coverage on disparities in mortality: Health care reform in Colombia, 1998-2007. Am J Public Health. 2013;103(3):100-6.

de Vries E, Arroyave I, Pardo C, Wiesner C, Murillo R, Forman D, et al. Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007. J Epidemiol Community Health. 2015;69(5):408-15.

DANE. Estimaciones y proyecciones de población, 1985-2020. Estimación y proyección de población nacional, departamentales y municipales por grupos quinquenales de edad y edades simples de 0 a 26 años, 1985-2020; 2007. Cited 2017 Sep 26. Available from: http://www.dane.gov.co/index.php?option=com_content&view=article&id=75&Itemid=72.

Arias-Ortiz NE, López-Guarnizo G. Evaluación de calidad de los datos del Registro Poblacional de Cáncer de Manizales, Colombia. Rev Colomb Cancerol. 2013;17(4):132-41.

López-Guarnizo G, Arias-Ortiz N, Arboleda-Ruiz W. Cancer incidence and mortality in Manizales 2003-2007. Colomb Méd (Cali). 2012;43(4):281-9.

Pardo C, Cendales R. Incidencia, mortalidad y prevalencia de Cáncer en Colombia 2007-2011. Instituto Nacional De Cancerologia: Bogotá; 2015. 148 p.

Forman D, Bray F, Brewster D, Gombe-Mbalawa C, Kohler B, Piñeros M, et al., editors. Cancer Incidence in Five Continents, vol. X. IARC Scientific Publication No164. Lyon: International Agency for Research on Cancer WHO; 2014.

Tyczynski J, Demaret E, Parkin D. Standards and Guidelines for Cancer Registration in Europe. IARC Technical Publication No. 40. WHO: France; 2003.

Singh GK, Miller BA, Hankey BF, Edwards B. Area socioeconomic variations in U.S CAncer incidence, mortality, stage, treatment and survival, 1975-1999. NCI Cancer Surveillance Monogrph Series. Bethesda, MD; 2003.

Calderón CAA, Botero JC, Bolaños JO, Martínez RR. Sistema de salud en Colombia: 20 años de logros y problemas. Cien Saude Colet. 2011;16(6):2817-28.

Bonilla L. Dimensión regional de las desigualdades en Colombia. 1a Ed. Bogotá: Banco de la República; 2011. 340 p.

Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: Analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet.

;385(9972):977-1010.

De Angelis R, Sant M, Coleman M, Francisci S, Baili P, Pierannunzio D, et al. Cancer survival in Europe 1999-2007: Results of EUROCARE-5-a population-based study. Lancet Oncol. 2014;15(1):23-34.

McDavid K, TC T, Sloggett A, MP C. Cancer survival in kentucky and health insurance coverage. Arch Intern Med. 2003;163(18):2135-44.

Restrepo JA, Bravo LE, García-Perdomo HA, García LS, Collazos P, Carbonell J. Incidencia, mortalidad y supervivencia al cáncer de próstata en Cali, Colombia, 1962-2011. Salud Publica Mex. 2014;56(5):440-7.

Hall SE, Holman CDAJ, Wisniewski ZS, Semmens J. Prostate cancer: Socio-economic, geographical and private-health insurance effects on care and survival. BJU Int. 2005;95(1):51-8.

Kuwahara A, Takachi R, Tsubono Y, Sasazuki S, Inoue M, Tsugane S. Socioeconomic status and gastric cancer survival in Japan. Gastric Cancer. 2010;13(4):222-30.

Wu C-C, Hsu T-W, Chang C-M, Yu C-H, Wang Y-F, Lee C-C. The effect of individual and neighborhood socioeconomic status on gastric cancer survival. PLoS One. 2014;9(2): e89655.

Brookfield KF, Cheung MC, Lucci J, Fleming LE, Koniaris LG. Disparities in survival among women with invasive cervical cancer: A problem of access to care. Cancer. 2009;115(1):166-78.

Niu X, Roche LM, Pawlish KS, Henry KA. Cancer survival disparities by health insurance status. Cancer Med. 2013;2(3):403-11.

Slatore CG, Au DH, Gould MK. An official American Thoracic Society systematic review: Insurance status and disparities in lung cancer practices and outcomes. Am J Respir Crit Care Med. 2010;182(9):1195-205.

Ou S-HI, Zell JA, Ziogas A, Anton-Culver H. Low socioeconomic status is a poor prognostic factor for survival in stage I nonsmall cell lung cancer and is independent of surgical treatment, race, and marital status. Cancer. 2008;112(9):2011-20.

Martinez S, Segura A, Arias S, Mateus G. Caracterización de los tiempos de atención y de mujeres con cáncer de mama que asistieron a un hospital de tercer nivel, 2005-2009. Rev Fac Nac Salud Pública. 2012;30(2):183-91.

Hernández JMR, Rubiano DPR, Barona JCC. Barreras de acceso administrativo a los servicios de salud en población Colombiana, 2013. Cien Saude Colet. 2015;20(6):1947-58.

Tervonen HE, Roder D, Morrell S, You H, Currow DC. Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival? Cancer Epidemiol. 2017;48:70-7.

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Received 2017-10-31
Accepted 2018-03-13
Published 2024-05-31