Survival Disparities among Cancer Patients Based on Mobility Patterns: A Population-Based Study.

Abstract

Background: Cancer is a major health problem worldwide. A growing number of cancer patients travel to hospitals outside their residential cities due to unbalanced medical resources. We aimed to evaluate the association between patterns of patient mobility and survival among patients with cancer. Methods: Data of patients hospitalized for cancer between January 2015 and December 2017 were collected from the regional data platform of an eastern coastal province of China. According to the cities of hospitalization and residency, 3 mobility patterns including intra-city, local center, and national center pattern were defined. Patients with intra-city pattern were sequentially matched to patients with the other 2 patterns on demographics, marital status, cancer type, comorbidity, and hospitalization frequency, using propensity score matching. We estimated 5-year survival and the associations between all-cause mortality and patient mobility. Results: Among 20,602 cancer patients, there were 17,035 (82.7%) patients with intra-city pattern, 2,974 (14.4%) patients with local center pattern, and 593 (2.9%) patients with national center pattern. Compared to patients with intra-city pattern, higher survival rates were observed in patients with local center pattern [5-year survival rate, 69.3% versus 65.4%; hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.77 to 0.95] and in patients with national center pattern (5-year survival rate, 69.3% versus 64.5%; HR, 0.80; 95% CI, 0.67 to 0.97). Conclusions: We found significant survival disparities among different mobility patterns of patients with cancer. Improving the quality of cancer care is crucial, especially for cities with below-average healthcare resources.