Deprivation and emergency admissions for cancers of colorectum, lung, and breast in south east England: ecological studyBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7153.245 (Published 25 July 1998) Cite this as: BMJ 1998;317:245
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Pollock and Vickers have provided a fascinating set of results but the reasons for their findings remain speculation. To impute the differences in care to failures of primary care seems unfair at this stage. They discuss a range of possible explanations but many other could also be relevant.
Day case treatment may require a certain level of facilities at home which are available less often in deprived areas. Another adult at home may also be a prerequisite. Single people may be more likely to live in deprived areas; patients from deprived areas may be more likely to have a working partner or one who cannot afford to take time off work or who has a job where such absences would be less acceptable.
Patients with lung cancer due to smoking, more common in areas where smoking is more prevalent, may be less likely to have an operable malignancy due to concomitant smoking-related disease. This is touched on in their discussion but limiting the study to admissions for which at least one FCE had a primary diagnosis of one of the three cancers does not give any information about comorbidity.
I have added to Pollock and Vickers' list of suggestions. Others could no doubt add further hypotheses. I hope further research will be carried out to help elucidate the reasons behind the discrepancies they have found. This is be ideal situation in which to use both qualitative and quantitative research methods to study patients' and professionals' experiences as patients pass through the system in order to discover the reasons behind apparently inequitable access and/or treatment decisions. Perhaps allocation of blame should wait until such results are available.
Competing interests: No competing interests