Cancer and chronic disease screening lowest in disadvantaged neighbourhoods: study

16/09/2013

A significant portion of people living in Ontario’s most disadvantaged neighbourhoods are not getting screened for cancer, diabetes and high cholesterol, putting them at increased risk of disease, say researchers in a study released today by the Institute for Clinical Evaluative Sciences (ICES).

The findings, published in the Canadian Journal of Public Health, found screening for cancer, diabetes and high cholesterol lower among Ontario men and women living in neighbourhoods with a low average income and high proportion of immigrants.

“Screening for cancer and chronic diseases are among the lowest in Ontario for socioeconomically disadvantaged groups, making these populations especially vulnerable to late diagnosis,” said lead author and ICES senior scientist Dr. Lawrence Paszat. “Our study found levels of screening were higher for diabetes and high cholesterol than cancer, suggesting new screening strategies are necessary to increase screening participation and reduce the burden of disease.”

Researchers reviewed the screening uptake of nearly 7.7 million people living in Ontario in 2009 for cancer — colorectal, cervical and breast — and diabetes and high cholesterol. The researchers found:

Overall, 75 per cent had at least one screening test
Screening for colorectal and breast cancers were the lowest — 61.2 per cent for women and 54.8 per cent for men (colorectal) and 59.3 per cent (breast)
Diabetes and high cholesterol screening levels were highest: 71.1 per cent for women, 59.9 per cent for men (diabetes), and 80.6 per cent for women and 68.7 per cent for men (cholesterol)
Men had a consistently lower screening uptake than women for all diseases
People living in low income, high-immigration neighbourhoods had the lowest cancer screening rates: 48.6 per cent for women and 40.6 per cent for men (colorectal), 52 per cent (cervical) and 45.7 per cent ( breast)
People living in low income, high-immigration neighbourhoods had lower uptake of diabetes and cholesterol screening than their more advantaged counterparts: 52 per cent and 61 per cent of men compared to 74 per cent and 83 per cent of women in higher income, lower immigration neighbourhoods

“Current practice is not eliminating disparities in screening for individuals living in low income, high-immigration neighbourhoods,” Dr. Paszat said. “We need to develop better strategies to improve screening overall.”

According to the researchers, disparities may exist because low-income individuals are not visiting a family doctor due to the cost of transportation or missing time from work. Additionally, language and literacy barriers may also pose challenges.

Authors: Borkhoff CM, Saskin R, Rabeneck L, Baxter NN, Liu Y, Tinmouth J, Paszat LF.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.