ArticleBMJ supportive & palliative care2019
Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance.
Article in BMJ supportive & palliative care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed, 8 citations in OpenAlex.
- The impact of rural health insurance on vulnerability to chronic poverty among rural residents in China: analysis using Probit and IVprobit models.Frontiers in public health · 2024Article
- ASSOCIATION BETWEEN SURGICAL VOLUME AND MORTALITY FROM COLON CANCER IN COLOMBIA: A NATIONAL COHORT.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2024Article
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Authors and funding
10 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundMany Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California.
methodsWe analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year. We obtained data on health insurance, census tract-based socioeconomic status and county-level physician supplies. Poor neighbourhoods were oversampled and the criterion was receipt of chemotherapy. Effects were described with rate ratios (RR) and tested with logistic regression models.
resultsPalliative chemotherapy was received by less than half of the participants (45%). Facilitating effects of primary care (RR=1.23) and health insurance (RR=1.14) as well as an impeding effect of specialised care (RR=0.86) were observed. Primary care physician (PCP) supply took precedence. Adjusting for poverty, PCP supply was the only significant and strong predictor of chemotherapy (OR=1.62, 95% CI 1.02 to 2.56). The threshold for this primary care advantage was realised in communities with 8.5 or more PCPs per 10 000 inhabitants. Only 10% of participants lived in such well-supplied communities.
conclusionsThis study's observations of facilitating effects of primary care and health insurance on palliative chemotherapy for metastasised colon cancer clearly suggested a way to maximise Affordable Care Act (ACA) protections. Strengthening America's system of primary care will probably be the best way to ensure that the ACA's full benefits are realised. Such would go a long way towards facilitating access to palliative care.
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