ESTIMATING POTENTIAL SAVINGS IN CANCER DEATHS BY ELIMINATING REGIONALAND SOCIAL-CLASS VARIATION IN CANCER SURVIVAL IN THE NORDIC COUNTRIES

Study objectives-To examine equity in the health care system with rega rd to cancer patient care by estimating the level of systematic region al variation in cancer survival in the Nordic countries. Specifically, those cancer sites which exhibit high levels of systematic regional v ariation in survival and hence inequity were identified. Estimating th e reduction in cancer deaths which could be achieved by eliminating th is variation so that everyone receives effective care will provide a r eadily interpretable measure of the amount of systematic regional vari ation. A comprehensive analysis of regional variation in survival has not previously been conducted so appropriate statistical methodology m ust be developed. Setting and participants-All those aged 0-90 years w ho had been diagnosed with at least one of 12 common malignant neoplas ms between 1977 and 1992 in Denmark, Finland, Norway, and Sweden. Desi gn-A separate analysis was conducted for each country. Regression mode ls for the relative survival ratio were used to estimate the relative risk of excess mortality attributable to cancer in each region after c orrecting for age and sex. An estimate of the amount of systematic reg ional variation in survival was obtained by subtracting the estimated expected random variation fi om the observed regional variation. An es timate was then made of the potential reduction in the number of cance r deaths for 2008-12 if regional variation in survival were eliminated so that everyone received the same level of effective care.Main resul ts-Between 2008 and 2012, an estimated 2.5% of deaths from cancers in the 12 sites studied could be prevented by eliminating regional variat ion in survival. The percentage of potentially avoidable deaths did no t depend on country or sex but it did depend on cancer site. There was no relationship between the level of regional variation in a given co untry and the level of survival. The cancer sites for which the greate st percentage savings could be achieved were melanoma (11%) and cervix uteri (6%). The sites for which the highest number of deaths could be prevented were prostate, colon, melanoma, and breast.