Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

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BMC cancer. 2021 Oct 14;21(1):1104. doi: 10.1186/s12885-021-08837-x.

ABSTRACT

BACKGROUND: While the underlying mechanisms and pathways of social inequalities in cancer survival have been extensively studied in adults, this is less so for children with cancer. Presumed mechanisms include prediagnostic use of and navigation through the health care system, which may differ according to the socioeconomic resources of the families. In this nationwide registry-based study, we investigated the association between measures of the socioeconomic position of the family in relation to prediagnostic health care contacts and the stage of disease at diagnosis in children with cancer in Denmark.

METHODS: We identified all children with cancer aged 0-15 years in 1998-2016 (N = 3043) from the Danish Child Cancer Registry. We obtained extensive information on measures of socioeconomic position, parental health and prediagnostic contacts with both general practitioners and hospitals 24 months prior to diagnosis from several national registries. We fitted multivariate conditional logistic regression models for the association of socioeconomic and health-related family variables with firstly frequent care contacts and secondly advanced stage.

RESULTS: We found higher odds ratios (OR) of frequent contacts with both general and emergency health care in the last 3 months before diagnosis in children from households with a short parental education and a mixed affiliation with the labor market, compared with children with high socioeconomic family position . Furthermore, children of parents with depression or of non-Western descent, respectively, had a higher OR for frequent general contact and emergency contacts. We found no association between socioeconomic position, parental health and disease stage.

CONCLUSION: Families with socioeconomic disadvantage, non-Western descent, or depression are more likely to use prediagnostic health care, both in general and in the acute setting, indicating that some underprivileged families have difficulty navigating the health care system when their child is ill. Reassuringly, this was not reflected in differences in stage at diagnosis. In order to improve the diagnostic process and possibly reduce care contacts, attention and support should be given in a short time to families with many care contacts.

PMID:34649500 | DOI:10.1186/s12885-021-08837-x

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