Dr Mustafa Shawihdi and colleagues from the United Kingdom determined whether variation in gastroscopy rates in English general practice populations is associated with inequality in esophagogastric cancer outcome.
The team performed a retrospective observational study of the Hospital Episode Statistics (HES) dataset for England (2006–2008) linked to death registration.
Methods were validated using independent local and national data.
General practices with new cases of esophagogastric cancer were included.
Practices were grouped into tertiles according to standardized elective gastroscopy rate per capita.
Outcome measures for cancer cases were: emergency admission during diagnostic pathway, major surgical resection and mortality at 1 year.
|Inequality was widest for the most socioeconomically deprived cases|
Covariates included age group, gender, comorbidity, general practice average deprivation and patient deprivation.
The team identified 22,488 incident cases of esophagogastric cancer from 6513 general practices.
Patients registered with the low tertile group of practices had the lowest rate of major surgery, highest rate of emergency admission and highest mortality.
The researchers observed that the inequality was widest for the most socioeconomically deprived cases.
After adjustment for covariates in logistic regression, the gastroscopy rate at the patient's general practice was an independent predictor of emergency admission, major surgery and mortality.
Dr Shawihdi's team concludes, "There is wide variation in the rate of gastroscopy among general practice populations in England."
"On average, esophagogastric cancer patients belonging to practices with the lowest rates of gastroscopy are at greater risk of poor outcome."
"These findings suggest that initiatives or current guidelines aimed at limiting the use of gastroscopy may adversely affect cancer outcomes."