Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

BMC Cancer

Jeanette Falck Winther¹  Hanne Bækgaard Larsen²  Lisa Lyngsie Hjalgrim²  Kjeld Schmiegelow²  Line Hjøllund Pedersen²  Friederike Erdmann³  Gitte Lerche Aalborg⁴  Susanne Oksbjerg Dalton⁵ 

[1] Childhood Cancer, Danish Cancer Society Research Center;Department of Paediatrics and Adolescent Medicine, Rigshospitalet;Division of Childhood Cancer Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz;Statistics and Data Analysis, Danish Cancer Society Research Center;Survivorship and Inequality in Cancer, Danish Cancer Society Research Center;

关键词: Childhood;    Childhood cancer;    Socioeconomic position;    Social inequality;    Prediagnostic contacts;    Denmark;   

DOI  :  10.1186/s12885-021-08837-x

来源: DOAJ

【 摘 要 】

Abstract Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

【 授权许可】

Unknown