HEALTH-CARE PATTERN AND COLORECTAL-CANCER - STUDY OF THE COTE-DOR POPULATION BETWEEN 1976 AND 1990

Objective. - The goal of this study was to analyze the characteristics of colorectal cancer patients associated with the distribution of the incident cases in the health care pattern (public, private and mixed health care options) and to study the development of this distribution over time. Methods. - The study concerned 3,403 cases of colorectal c ancer diagnosed in the Cote-d'Or region, France between 1976 and 1990. The relationship between patient characteristics and the type of heal th care pattern was analyzed using a polychotomous logistic regression model. Results. - Data analysis indicates an uneven patient distribut ion among the public (40.6 %), private (47.3 %) and mixed (12.1 %) sec tors. The proportion of patients received in the public sector increas ed with the age of the patient with a proportional decrease in private and mixed sectors. compared with patients under 65 years cared for in the public sector, the odds ratio characteristic of the private secto r was 0.74 for the age group 65-74 and 0.44 for those over 74 years. T he odds ratios characteristic of the mixed sector were 0.71 and 0.41 r espectively. Cases demonstrating symptoms received care more often in the private sector (48.3 %) than in the public (38.7 %) or mixed (13 % ) sectors, whereas those diagnosed in patients with no digestive disor ders as well as those diagnosed in emergency situations were mainly ca red for in the public sector. Cancers in advanced stages,were more oft en treated in the public sector. In the case of palliative treatment, the patients were more often treated in the public sector than in the private sector or mixed sector. This phenomenon was more marked in the case of symptomatic treatments: with curative treatment taken as the category of reference, the odds ratios associated with symptomatic tre atment were 0.38 for the private sector and 0.18 for the mixed sector. Over the period of time examined, there was an increase in the propor tion of patients receiving care in the private sector when they lived in the area serviced by Dijon or in areas without a health << structur e >>. Patients residing in areas with a general hospital unchanged ove r time. Relatively disadvantage social categories were more often asso ciated with care in the public sector. Conclusions. - This study shows that the characteristics of colorectal cancer patients differ between the public and private sectors. It shows the differences in recruitme nt of health care structures according to the treatment of those patie nts. The study provides information useful in conceiving regional sche mes of health care organisation.