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Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics

BMJ 2010; 340 doi: (Published 15 January 2010) Cite this as: BMJ 2010;340:b5479
  1. Rosalind Raine, professor of health care evaluation1,
  2. Wun Wong, honorary research fellow1,
  3. Shaun Scholes, honorary research fellow1,
  4. Charlotte Ashton, specialty registrar in public health1,
  5. Austin Obichere, consultant colorectal surgeon2,
  6. Gareth Ambler, lecturer in statistics3
  1. 1Department of Epidemiology and Public Health, University College London, London WC1E 6BT
  2. 2University College London Hospital, London NW1 2PG
  3. 3Department of Statistical Science, University College London
  1. Correspondence to: R Raine r.raine{at}
  • Accepted 19 October 2009


Objectives To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer.

Design Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006.

Setting Hospital episode statistics (HES) dataset.

Participants 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer.

Main outcome measures Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment.

Results Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0.52 (0.46 to 0.59).

Conclusions Despite the implementation of the NHS Cancer Plan, social factors still strongly influence access to and the provision of care.


  • We thank Richard Morris, Madhavi Bajekal, and the reviewers for their valuable comments.

  • Contributors: RR had the idea for the research, led the study, and is guarantor. RR and GA collaborated on the study design and interpretation of results. CA contributed to the study design. GA led the statistical analysis. WW and SS undertook the analysis. AO provided expert clinical advice. All authors contributed and commented on drafts of the article and approved the final version.

  • Funding: RR is partly funded by a National Institute for Health Research public health career scientist award and by the National Institute for Health Research University College London Hospital/University College London Comprehensive Biomedical Research Centre. WW and SS are funded by Legal and General Group. AO is partly funded by CRUK. The research was funded in part by the actuarial profession (Institute of Actuaries in England and Wales and the Faculty of Actuaries in Scotland). The authors’ work was independent of the funders.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the Information Governance, Information Centre for Health and Social Care (reference No ET1366).

  • Data sharing: No additional data available.

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