American Journal of Public Health
Adult, Aged, Breast Neoplasms/mortality, Breast Neoplasms/therapy, Confounding Factors (Epidemiology), Female, Hawaii/epidemiology, Health Benefit Plans, Employee/statistics & numerical data, Health Services Research, Humans, Income/statistics & numerical data, Insurance Coverage/statistics & numerical data, Insurance, Health/classification Insurance, Health/statistics & numerical data, Male, Middle Aged, National Health Programs/statistics & numerical data, Ontario/epidemiology, Prostatic Neoplasms/mortality, Prostatic Neoplasms/therapy, Quality of Health Care, Single-Payer System/statistics & numerical data, Socioeconomic Factors, Survival Analysis, Universal Coverage/statistics & numerical data, Urban Health/statistics & numerical data
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.
Gorey, Kevin M.. (2000). An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii. American Journal of Public Health, 90 (12), 1866-1872.