The influence of geographical access to health care and material deprivation on colorectal cancer survival : Evidence from France and England

A partir des données de trois registres français et d'un registre anglais des cancers portant sur 40 613 cas, cette étude analyse, en France et en Angleterre, l'association entre l'accès géographique aux soins de santé, la pauvreté et la survie de patients atteints d'un cancer colorectal diagnostiqué entre 1997 et 2004

Résumé en anglais

This article investigates the influence of distance to health care and material deprivation on cancer survival for patients diagnosed with a colorectal cancer between 1997 and 2004 in France and England. This population- based study included all cases of colorectal cancer diagnosed between 1997 and 2004 in 3 cancer registries in France and 1cancer registry in England (N : 40 613). After adjustment for material deprivation, travel times in England were no longer significantly associated with survival. In France patients living between 20 and 90 min from the nearest cancer unit tended to have a poorer survival, although his was not statistically significant. In England, the better prognosis observed for remote patients can be explained by associations with material deprivation; distance to health services alone did not affect survival whilst material deprivation level had a major influence, with lower survival for patients living in deprived areas. Increases in travel times to health services in France were associated with poorer survival rates. The pattern of this influence seems to follow an inverse U distribution, i.e. maximal for average travel times.