TY  - JOUR
A1  - Stangl, Stephanie
A1  - Rauch, Sebastian
A1  - Rauh, Jürgen
A1  - Meyer, Martin
A1  - Müller‐Nordhorn, Jacqueline
A1  - Wildner, Manfred
A1  - Wöckel, Achim
A1  - Heuschmann, Peter U.
T1  - Disparities in Accessibility to Evidence-Based
Breast Cancer Care Facilities by Rural and Urban Areas in Bavaria, Germany
JF  - Cancer
N2  - Background
Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care.

Methods
Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof‐of‐concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population‐based Cancer Registry of Bavaria were linked at the district level.

Results
Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho‐oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes.

Conclusions
Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high‐quality health care to all inhabitants, regardless of residence.
KW  - accessibility
KW  - breast cancer
KW  - evidence‐based medicine
KW  - geographic information science
KW  - health care service research
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239854
VL  - 127
IS  - 13
SP  - 2319
EP  - 2332
ER  -