Regional and socio-economic variation in survival after glioblastoma in Denmark, 2013-2018.

INTRODUCTION: Glioblastoma is the most frequent primary brain tumour in adults. In Denmark, the treatment of glioblastoma is centralised to four neurosurgical and oncological departments located in four of the five Danish administrative regions. The aim of this study was to examine the regional and socioeconomic variation in survival after a diagnosis of glioblastoma in Denmark. METHODS: We included 1,731 patients with histologically confirmed glioblastoma from 2013 to 2018 registered in the Danish Neuro-oncology Registry. The data sources were the Danish National Registries. The exposure was region of residence at diagnosis and household income in the year before diagnosis. Follow-up was initiated at diagnosis and concluded at death or end-of-follow-up on 15 July 2019. Cox regression was used to examine overall mortality by exposure. RESULTS: With adjustment for age, sex, year of diagnosis and comorbidity, mortality rates of glioblastoma patients varied significantly between regions and were lowest in the Region of Southern Denmark and highest in the Capital Region (hazard ratio = 0.79; 95% confidence interval: 0.68-0.91, compared with the Capital Region). Further adjustment for surgical resection attenuated the regional differences in mortality. Income was not a predictor of survival. CONCLUSIONS: We found significant regional variation in survival after a diagnosis of glioblastoma. Differences in treatment patterns between regions may explain part of this mortality variation. Household income and education level did not explain the regional differences. FUNDING: none. TRIAL REGISTRATION: not relevant.

Regional and socio-economic variation in survival after a pancreatic cancer diagnosis in Denmark.

INTRODUCTION: Pancreatic cancer is among the most lethal malignancies with a five-year survival of about 5%, and the only curative treatment is surgical resection. Denmark consists of five governmental regions and has four surgical centres. Our aim was to explore the regional and socio-economic differences in overall survival following a pancreatic cancer diagnosis in Denmark. METHODS: We included a total of 5,244 pancreatic cancer patients (WHO International Classification of Diseases, tenth version C25) registered in the Danish Pancreatic Cancer Database during 2012-2017. The data sources used were the Danish Civil Registration System, the Danish National Patient Registry and the Danish national registers on education and income at Statistics Denmark. Cox regression analysis was used to examine all-cause mortality of pancreatic cancer patients by region of residence and socio-economic status. RESULTS: Compared to The Capital Region, there was an excess mortality in the Central Denmark Region and the North Denmark Region in both men and women, whereas no increased mortality was observed in the Region of Southern Denmark or in Region Zealand. Estimates were adjusted for age, year of diagnosis and comorbidity. Adjustment for surgical resection greatly attenuated the variation in survival between the regions. CONCLUSIONS: We found significant differences in overall survival across the five Danish regions following a diagnosis of pancreatic cancer. The regional variation in survival was largely attributable to differences in the propensity to use surgical resection. FUNDING: none. TRIAL REGISTRATION: not relevant.

Regional and socioeconomic variation in survival of melanoma patients in Denmark.

INTRODUCTION: This article explores variation in survival and mortality of Danish melanoma patients from 2012 to 2017 in relation to their region of residence and socioeconomic status. METHODS: Data were extracted from The Danish Melanoma Database, a clinical register, based on reports from hospital departments and dermatologists, and designed for quality improvement. The analysis included covariates at the person and tumour level. A cohort analysis was implemented to quantify the variations and identify the underlying mechanisms behind regional and socioeconomic variations in mortality of melanoma patients. RESULTS: The mortality of melanoma patients varied between the five regions with mean hazard ratios (95% confidence interval) of 1.36 (1.07-1.74) in men and 1.44 (1.08-1.92) in women between the regions with highest and lowest mortality. Mortality was highest in the patients with the lowest income and shortest education. Regional variation in mortality was attributable to underlying variation in tumour stage and thickness, and it was not confounded by other covariates. CONCLUSIONS: The two regions with the lowest mortality (highest survival) had high absolute incidence rates of stage IA and thin melanomas, indicating a high level of diagnostic activity in these regions. There was no regional variation in the incidence of advanced melanoma. The optimal level of diagnostic investigation of skin lesions has yet to be established. FUNDING: none. TRIAL REGISTRATION: not relevant.

Career dreams among health care students: I want to make a difference.

There is a continuous increase in demand for health services in most countries because people who are older are living longer. Health care for people who are older is not, generally, an attractive career option for undergraduate health professionals. This study investigated career dreams among undergraduates studying a variety of health care subjects to understand what motivates them. Eighteen focus groups were conducted with 90 students, and template analysis was performed within a sociological framework. Four themes emerged from the analysis: no plans to work with people who are older, dreaming of making a difference, seeking variety, and the impact of clinical placements on stimulating or reducing interest in working with people who are older. Geriatrics and gerontology do not offer the opportunities that students are looking for in their future careers. There is a need to change the way we talk about adults who are older everywhere, not just in health care training. However, health care educators should also help students to understand the value of care provided to adults who are older.