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Examining Disparities in Cancer Control

February 28, 2014

Report Highlights

Examining Disparities in Cancer Control: A System Performance Special Focus Report is part of the System Performance Special Focus Report series by the Canadian Partnership Against Cancer. The series focuses on specific topics or domains within the cancer control system, providing indicators and analyses that help highlight best practices and identify opportunities for system improvements across the country. This report focuses on equity by providing some objective, data-driven answers to the following question: To what extent are there disparities among Canadians in their risk of cancer, their access to cancer control services and their care outcomes, based on their income, whether they are immigrants or Canadian-born and whether they live in urban, rural or remote communities?

Two of the pillars of the Canadian health-care system are universality, which according to the Canada Health Act requires that “all residents have access to public health care insurance and insured services on uniform terms and conditions,” and accessibility, which according to the Act requires that “insured persons must have reasonable and uniform access to insured health services, free of financial or other barriers.1 No one may be discriminated against on the basis of such factors as income, age, and health status.” This report presents measurement and analysis of the impact of three factors commonly cited as barriers to access: low neighbourhood income level, residential rurality and remoteness, and individual immigrant status and neighbourhood immigrant density.

The goal of this report is to shed light on the extent to which indices of income, immigrant status and rurality/remoteness affect access to cancer control services in Canada. The report is not intended as a definitive treatise on this topic but rather as a source of objective data that can help in exploring some key questions. This report addresses the rates at which these populations get screened for cancer, get diagnosed at an early treatable stage, wait for treatment, receive treatment and are enrolled in clinical trials. In addition, the report examines the extent to which outcomes measured using incidence, mortality and survival vary across these sub-populations. Because potential factors for variations are not restricted to problems around access to health-care services, the report also examines the prevalence of risk factors such as smoking, alcohol consumption and obesity in the different population segments.

The results presented here confirm previous findings from similar studies both in Canada and other developed countries, but also highlight new information, including a number of novel and sometimes unexpected findings. As is the case with such studies, the results often lead to as many new questions as they answer. Some of the results highlights are provided below. Please note that owing to the different data sources for different indicators, some results are based on individual household income and immigrant status (CCHS-based indicators) while all others are based on area-level (neighbourhood) income and immigrant density.