Childhood cancer survival disparities in a universalized health system in Cali, Colombia

• Main Authors: Oscar Ramirez (Author), Paula Aristizabal (Author), Alia Zaidi (Author), Anne Gagnepain-Lacheteau (Author), Raul C. Ribeiro (Author), Luis E. Bravo (Author)
• Format: Book
• Published: Elsevier, 2018-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Universal healthcare has been proposed as a strategy to achieve health equity. Herein, we describe childhood cancer survival disparities within a universal healthcare system in Cali, the third largest city in Colombia. We prospectively included data from Cali's childhood cancer surveillance system (VIGICANCER) cohort (2009-2016) and adjusted the hazard ratios (aHR) for confounders using multivariate Cox regression. We included 1808 patients with a median age for children (n = 1499) of 6 years and for adolescents (n = 309) of 17 years. Fifty-six percent were male, 14% were afro-descendants, 61% resided outside of Cali, 52% had public insurance, 44% had private insurance, and 4% were uninsured. Five-year overall survival rates for patients with private insurance, public insurance and uninsured patients were 62% (95% CI: 58, 66), 43% (95% CI: 39, 46) and 23% (95% CI: 13, 35), respectively. Compared to private insurance, mortality among patients with public insurance (aHR = 1.6; 95% CI: 1.3, 1.9) and uninsured (aHR = 2.7; 95% CI: 1.9, 4.0) was higher. We found significant disparate survival outcomes, primarily by insurance and tumor type. Higher treatment abandonment, higher treatment-related mortality, and advanced disease at diagnosis partially explained these disparities. Survival inequalities persist in Colombia despite an established universal healthcare system aimed at providing equal care for all. Keywords: Health disparities, Universal health care coverage, Survival, Childhood, Epidemiology, Cancer, Treatment outcome

Item Description

2468-1245
10.1016/j.phoj.2019.01.001