An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii

OBJECTIVES: Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS: Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person\u27s residence at the time of diagnosis were taken from population censuses. RESULTS: Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS: Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii\u27s employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system

Cancer differentials among US blacks and whites: quantitative estimates of socioeconomic-related risks

This article analyzes 10 studies that assessed the association of socioeconomic status (SES) with cancer occurrence among blacks and whites in the United States. The following summative inferences were made: the associations of SES with cancer are similar among blacks and whites; cancers of organ sites with the most intimate environmental interfaces have the strongest SES-cancer associations (stomach, lung, cervix, and rectum); the prevalence of exposure to low socioeconomic-related risks such as poverty are approximately fourfold greater among blacks; the all-site population attributable risk percent due to low socioeconomic exposure among blacks is estimated to be four times that of whites, and similar data trends were observed for individual cancer sites such as the stomach and lung; and the three cancer sites of the stomach, lung, and cervix uteri account for nearly half of the observed US black-white cancer rate difference. This review also found all 10 of the primary studies in this field to be ecological with respect to socioeconomic exposure measurement, ie, they used aggregate measures (eg, census tract median education or family income) to characterize the individual\u27s exposure. The need for direct empirical validation of such measures to aid in interpretation of the extant data in this field is underscored

The association of near poverty status with cancer incidence among black and white adults

This cumulative incidence study was accomplished among adults in Upstate New York metropolitan areas (Buffalo, Rochester, Syracuse and Albany--1979-1986). It used a new ecological socioeconomic status measure--near poverty status (i.e., below 200% of the federally established poverty criterion, including the poor and near poor)--and observed its association with site-specific cancer incidence (lung, stomach, cervix uteri, prostate, colon, rectum and breast). Findings were: 1) near poverty status is directly associated with each cancer site\u27s incidence and the strength of the associations are similar among blacks and whites for each one and 2) the prevalence of exposure, of living in high near impoverishment areas, is nearly seven-fold greater among blacks; prevalence ratio [PR] = 6.74 (95% confidence interval [CI]:5.07,8.99)

Increased racial differences on breast cancer care and survival in America: historical evidence consistent with a health insurance hypothesis, 1975-2001

PURPOSE: This study examined whether race/ethnicity had differential effects on breast cancer care and survival across age strata and cohorts within stages of disease. METHODS: The Detroit Cancer Registry provided 25,997 breast cancer cases. African American and non-Hispanic white, older Medicare-eligible and younger non-eligible women were compared. Successive historical cohorts (1975-1980 and 1990-1995) were, respectively, followed until 1986 and 2001. RESULTS: African American disadvantages on survival and treatments increased significantly, particularly among younger women who were much more likely to be uninsured. Within node positive disease all treatment disadvantages among younger African American women disappeared with socioeconomic adjustment. CONCLUSIONS: Growth of this racial divide implicates social, rather than biological, forces. Its elimination will require high quality health care for all

Secular trends in the United States black/white hypertension prevalence ratio: potential impact of diminishing response rates

In this integrative review, the authors analyzed 25 studies on hypertension prevalence among black and white adults (1960-1991). The authors made the following inferences: 1) both female (2.59 vs. 1.77) and male (2.20 vs. 1.38) black/white hypertension prevalence ratios have diminished by approximately a third over the past three decades; 2) response rates were significantly lower among the more recent surveys (i.e., 1976 or later, mean 69.2 percent (standard deviation (SD) 6.9) vs. 1960 to 1975, mean 86.1 percent (SD 9.1)); and 3) these two trends are directly associated--response rates may account for a third (women, R2 = 0.362) to nearly a half (men, R2 = 0.469) of the variability in black-white hypertension differentials. These findings suggest that although respondent-based research has found black and white adults in the United States to be increasingly similar in hypertension prevalence, the same may not be true of the entire adult population (responders and nonresponders). The apparent diminishment over time in the black-white hypertension gap is as likely to be a methodological artifact allied with declining response rates as a true parametric phenomenon resultant from substantive factors such as enhanced treatment effectiveness among blacks

Associations of physician supplies with colon cancer care in Ontario and California, 1996 to 2006

BACKGROUND: This study examined the differential effects of physician supplies on colon cancer care in Ontario and California. The associations of physician supplies with colon cancer stage at diagnosis, receipt of surgery and adjuvant chemotherapy, and 5-year survival were observed within each country and compared between-country. METHODS: Random samples of Ontario and California cancer registries provided 2,461 and 2,200 colon cancer cases that were diagnosed between 1996 and 2000, and followed until 2006. Both registries included data on the stage of disease at the time of diagnosis, receipt of cancer-directed surgery, receipt of adjuvant chemotherapy, and survival. Census tract-level data on low-income prevalence were, respectively, taken from 2001 and 2000 Canadian and United States population censuses. County-level primary care physician and gastroenterologist densities were computed for the same years. RESULTS: Significant income-adjusted, gastroenterologist density threshold effects (2.0 or more vs. less than 2.0 per 100,000 inhabitants) were observed for early diagnosis (OR = 1.57) and 5-year survival (OR = 1.63) in Ontario, but not in California. Significant incremental threshold effects of primary care physician densities on chemotherapy receipt (8.0 and 9.0 or more per 10,000 inhabitants, respective ORs of 1.79 and 2.37) were also only observed in Ontario. CONCLUSIONS: These colon cancer care findings support the theory that while personal economic resources are more predictive in America, community-level resources such as physician supplies are more predictive of health care access and effectiveness in Canada

Breast cancer care in Canada and the United States: ecological comparisons of extremely impoverished and affluent urban neighborhoods

This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, non-receipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian breast cancer care advantages

The Effectiveness of Feminist Social Work Methods: An Integrative Review

This integrative review of the effectiveness of feminist social work methods compared 35 independent studies of feminist interventions with 44 independent studies of social work practice that were based on other theoretical orientations. Feminist interventions were observed to be more effective than those based on other practice models. And among feminist social work interventions, radical methods seemed to be more effective than liberal methods. These findings are consistent with a theory by target system interaction that was suggested by a previous meta-analysis (Gorey, Thyer, & Pawluck, 1998). While personal theoretical orientations such as cognitive-behavioral modes of practice seem more supportive of individual client change, systemic-structural models, including feminist ones, seem to be more effective in supporting mutual client-worker strategies to change larger system targets. This study’s review-generated finding of feminist, specifically radical feminist, social work’s differential effectiveness is essentially a screened hypothesis. Its validity remains to be tested with well controlled primary research

Breast cancer survival in ontario and california, 1998-2006: socioeconomic inequity remains much greater in the United States

This study re-examined the differential effect of socioeconomic status on the survival of women with breast cancer in Canada and the United States. Ontario and California cancer registries provided 1,913 cases from urban and rural places. Stage-adjusted cohorts (1998-2000) were followed until 2006. Socioeconomic data were taken from population censuses. SES-survival associations were observed in California, but not in Ontario, and Canadian survival advantages in low-income areas were replicated. A better controlled and updated comparison reaffirmed the equity advantage of Canadian health care