ArticleBMC cancer2011
Income level and regional policies, underlying factors associated with unwarranted variations in conservative breast cancer surgery in Spain.
Article in BMC cancer, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Understanding the effects of socioeconomic status along the breast cancer continuum in Australian women: a systematic review of evidence.International journal for equity in health · 2017Pooled it
- Identification and classification of principal features for analyzing unwarranted clinical variation.Journal of evaluation in clinical practice · 2024Review
- Geographic variation in attitudes regarding management of locally advanced pancreatic cancer.Surgery open science · 2022Article
- Atlas VPM: two decades informing on unwarranted variations in health care in Spain.Research in health services & regions · 2022Article
- Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery.JCO global oncology · 2020Article
- Socioeconomic status differs between breast cancer patients treated with mastectomy and breast conservation, and affects patient-reported preoperative information.Breast cancer research and treatment · 2020Article
- Article
- Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2014Review
- Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005-2011).BMC research notes · 2014Article
- Understanding of regional variation in the use of surgery.Lancet (London, England) · 2013Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGeographical variations in medical practice are expected to be small when the evidence about the effectiveness and safety of a particular technology is abundant. This would be the case of the prescription of conservative surgery in breast cancer patients. In these cases, when variation is larger than expected by need, socioeconomic factors have been argued as an explanation.
objectivesUsing an ecologic design, our study aims at describing the variability in the use of surgical conservative versus non-conservative treatment. Additionally, it seeks to establish whether the socioeconomic status of the healthcare area influences the use of one or the other technique.
methods81,868 mastectomies performed between 2002 and 2006 in 180 healthcare areas were studied. Standardized utilization rates of breast cancer conservative (CS) and non-conservative (NCS) procedures were estimated as well as the variation among areas, using small area statistics. Concentration curves and dominance tests were estimated to determine the impact of income and instruction levels in the healthcare area on surgery rates. Multilevel analyses were performed to determine the influence of regional policies.
resultsVariation in the use of CS was massive (4-fold factor between the highest and the lowest rate) and larger than in the case of NCS (2-fold), whichever the age group. Healthcare areas with higher economic and instruction levels showed highest rates of CS, regardless of the age group, while areas with lower economic and educational levels yielded higher rates of NCS interventions. Living in a particular Autonomous Community (AC), explained a substantial part of the CS residual variance (up to a 60.5% in women 50 to 70).
conclusionThe place where a woman lives -income level and regional policies- explain the unexpectedly high variation found in utilization rates of conservative breast cancer surgery.
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