Utilisation of primary care before a childhood cancer diagnosis: do socioeconomic factors matter?: A Danish nationwide population-based matched cohort study

Abstract

ObjectivesEarly diagnosis of childhood cancer is critical. Nevertheless, little is known about the potential role of inequality. This study aims to describe the use of primary care 2 years before a childhood cancer diagnosis and to investigate whether socioeconomic factors influence the use of consultations and diagnostic tests in primary care.DesignA national population-based matched cohort study.Setting and participantsThis study uses observational data from four Danish nationwide registers. All children aged 0–15 diagnosed with cancer during 2008–2015 were included (n=1386). Each case was matched based on gender and age with 10 references (n=13 860).Primary and secondary outcome measuresThe primary outcome was additional rates for consultations and for invoiced diagnostic tests for children with cancer according to parental socioeconomic factors. Furthermore, we estimated the association between socioeconomic factors and frequent use of consultations, defined as at least four consultations, and the odds of receiving a diagnostic test within 3 months of diagnosis.ResultsChildren with cancer from families with high income had 1.46 (95% CI 1.23 to 1.69) additional consultations 3 months before diagnosis, whereas children from families with low income had 1.85 (95% CI 1.60 to 2.11) additional consultations. The highest odds of frequent use of consultations was observed among children from low-income families (OR: 1.94, 95% CI 1.24 to 3.03). A higher odds of receiving an invoiced diagnostic test was seen for children from families with mid-educational level (OR: 1.46, 95% CI 1.09 to 1.95).ConclusionWe found a socioeconomic gradient in the use of general practice before a childhood cancer diagnosis. This suggests that social inequalities exist in the pattern of healthcare utilisation in general practice.

Are socio-economic inequalities in breast cancer survival explained by peri-diagnostic factors?

“…This may seem counter-intuitive given their more advanced disease at diagnosis and lower survival. However, it is consistent with other data from the UK [ 39 , 40 ], Denmark [ 41 ] and Australia [ 42 ], as well as with an ecological study of healthcare trusts in England which showed symptom awareness for breast cancer was similar across the socio-economic spectrum, although help-seeking behaviours were slightly lower in more deprived areas [ 43 ]. Breast cancer is characterised by especially short pre-diagnosis presentation intervals [ 44 ] which may suggest that the lack of association observed here between peri-diagnostic factors and survival is unique to this malignancy.…”

Parent’s perspectives of the pathway to diagnosis of childhood cancer: a matter of diagnostic triage

“…Delay has been raised as a possible explanation for social inequality in utilization of primary care [ 14 ] and survival among children with cancer, also within the Danish welfare state [ 46 ]. We are aware, the study design does not allow any conclusions about the influence of socioeconomic position [ 47 ] on events or outcomes along the cancer trajectory.…”

“…There is only limited research available about barriers to early diagnosis of childhood cancer and most of this research uses quantitative methods. Studies on diagnostic delay have examined predictors and medical systems [2,10,[14][15][16][17], showing how differences in HCS may account for variation in TTD [18][19][20][21]. Studies of parents' experiences and accounts of the pathway to diagnosis have also been conducted showing that, given the rarity of childhood cancer, parents do not immediately interpret their children's symptoms in the context of cancer, and many symptoms are initially managed without consulting a general practitioner (GP) [22].…”

Socioeconomic position, referral and attendance to rehabilitation after a cancer diagnosis: A population-based study in Copenhagen, Denmark 2010–2015

“…Implementation and/or reorganization of services may lead to socioeconomic differences in uptake. This has i.e., been observed for uptake and completion of the newly introduced HPV vaccination program in Danish adolescent girls [2]. Although knowledge about socioeconomic inequality in the provision of community-based rehabilitation for people with cancer is limited, recently published evidence points to social inequality in referral to rehabilitation [13,14].…”

“…Even though the health care system ensures tax-funded and equal access to health care, there is a marked social inequality in cancer prognosis in Denmark. This is documented at all levels from the GP [1,2] to the highly specialized multidisciplinary in-hospital cancer treatments (i.e., [3,4]). The social differences in prognosis are not trivial.…”