Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study
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Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark : a nationwide register study. / Pedersen, Line Hjøllund; Erdmann, Friederike; Aalborg, Gitte Lerche; Hjalgrim, Lisa Lyngsie; Larsen, Hanne Bækgaard; Schmiegelow, Kjeld; Winther, Jeanette Falck; Dalton, Susanne Oksbjerg.
I: BMC Cancer, Bind 21, 1104, 2021.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark
T2 - a nationwide register study
AU - Pedersen, Line Hjøllund
AU - Erdmann, Friederike
AU - Aalborg, Gitte Lerche
AU - Hjalgrim, Lisa Lyngsie
AU - Larsen, Hanne Bækgaard
AU - Schmiegelow, Kjeld
AU - Winther, Jeanette Falck
AU - Dalton, Susanne Oksbjerg
N1 - Publisher Copyright: © 2021, The Author(s).
PY - 2021
Y1 - 2021
N2 - Background: While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods: We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results: We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion: Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.
AB - Background: While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods: We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results: We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion: Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.
KW - Childhood
KW - Childhood cancer
KW - Denmark
KW - Diagnosis
KW - Prediagnostic contacts
KW - Register study
KW - Social inequality
KW - Socioeconomic position
KW - Stage
U2 - 10.1186/s12885-021-08837-x
DO - 10.1186/s12885-021-08837-x
M3 - Journal article
C2 - 34649500
AN - SCOPUS:85117299500
VL - 21
JO - B M C Cancer
JF - B M C Cancer
SN - 1471-2407
M1 - 1104
ER -
ID: 284087070