Disparities by type of insurance in the journey of cervical cancer care within the context of universal health coverage in Colombia.

Abstract

e13814 Background: The WHO launched an initiative for cervical cancer elimination, the 4th most common cancer among women worldwide, with 90% of deaths occurring in low and middle-income countries. Latin America faces the second highest mortality globally, but significant disparities are observed between and within countries. Colombia is a middle-income country with universal health insurance; accordingly, reduced disparities in cervical cancer care are expected. Thus, we analyzed differences between contributory and subsidized insurance regimens (IR) in Colombia, each one covering people with and without payment capacity; respectively. Methods: A nested retrospective cohort was analyzed. Patients aged 18 years and older newly diagnosed with locally advanced cervical cancer were consecutively recruited in reverse chronological order from January 2019 to June 2023. A sample size of 246 patients was considered for 80% full treatment compliance and 5% precision. Patients were equally distributed in two referral centers (one per IR). A comparison between IR was done about patterns of care, time to care, diagnostic resource use, and trajectory clusters. Missing sociodemographic data are described. Missing data on time to care were less than 5% with no difference between IR; thus, registers missing this information were dropped when analyzing the corresponding variable. Results: In total 125 patients in the contributory insurance regimen (CIR) and 136 in the subsidized insurance regimen (SIR) were recruited. The mean age was 53.1 and 50.4 in the CIR and SIR; respectively. Regarding sociodemographic variables only married condition showed significant differences (CIR 40.0%; SIR 58.8%). Screening history was missing over 50%, but screening-led diagnosis was more frequent in the SIR (22.8%) than in the CIR (15.2%). Inconsistently, the tumor size was > 4 cm in 93.4% of SIR patients vs 57.6% of CIR patients. The first consultation was done mainly with gynecology oncology with no differences between IR, yet we identified 26 different trajectories of cancer care in the CIR and 14 in the SIR. No significant differences in time to care were observed but standard of care significantly differ (table 1). Conclusions: Universal health insurance improves equity in access to cervical cancer care; however, quality of care deserves careful review and future studies evaluating treatment outcomes are highly desirable. Treatment pattern CIR SIR p value Time diagnosis to treatment (months, mean-SD) 3.4 (2.9) 3.2 (2.7) 0.546 Time first visit to treatment (months, mean-SD) 1.5 (3.8) 1.6 (1.9) 0.934 Total time chemo-radiation (months, mean-SD) 2.5 (0.5) 2.7 (1.4) 0.251 Interval brachytherapy (months, mean-SD) 0.5 (0.5) 0.9 (0.8) <0.001 Standard staging 60.2% 69.1% 0.134 Standard chemo-radiation 82.1% 91.9% 0.018 Full treatment compliance 73.2% 84.6% 0.024 Supportive care 82.9% 54.4% <0.001