Journal Article

An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii

Fehringer, G, Laukkanen, E, Holowaty, EJ, Gorey, KM, Richter, NL, Meyer, CM

2000

Overview

OBJECTIVES: Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS: Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. RESULTS: Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS: Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.

• Publisher: Am Public Health Assoc,American Public Health Association
• Subject: Adult / Aged / Biological and medical sciences / Breast Neoplasms - mortality / Breast Neoplasms - therapy / Canada / Cancer / Cities / Comparative studies / Confounding Factors (Epidemiology) / Female / Gynecology. Andrology. Obstetrics / Hawaii - epidemiology / Health Benefit Plans, Employee - statistics & numerical data / Health care industry / Health insurance / Health Services Research / Honolulu / Humans / Income - statistics & numerical data / Insurance Coverage - statistics & numerical data / Insurance, Health - classification / Insurance, Health - statistics & numerical data / International comparisons / Male / Mammary gland diseases / Medical sciences / Middle Aged / National Health Programs - statistics & numerical data / Nephrology. Urinary tract diseases / Ontario - epidemiology / Patients / Prostatic Neoplasms - mortality / Prostatic Neoplasms - therapy / Public health / Quality of Health Care / Quality of service / Rates / Single-Payer System - statistics & numerical data / Socioeconomic Factors / Survival / Survival Analysis / Toronto / Tumors / Tumors of the urinary system / Universal Health Insurance - statistics & numerical data / Urban Health - statistics & numerical data / Urinary tract. Prostate gland / USA