Healthcare networks and the waiting time to begin oral cancer treatment: An ecological study

Abstract

Objective

To analyze the total, direct, and indirect effects of services and work process on healthcare network points, namely, primary healthcare (PHC), secondary healthcare (SHC), and tertiary healthcare (THC), on the time to begin oral cancer treatment in Brazil.

Study design

Retrospective observational ecological study.

Methods

Data were obtained from the Brazilian Unified Health System, using health regions as units of analysis. The outcome was the proportion of oral cancer patients who waited >60 days to start treatment. Independent variables were represented by PHC, SHC, and THC data. Structural equation modeling assessed total, direct, and indirect effects on the outcome using standardized factor loadings (SFLs). Analyses were conducted at a 5 % significance level.

Results

Health regions that performed oral biopsies in PHC tended to begin the treatment earlier (Direct effect, SFL = −0.155, p = 0.038), and those with better socioeconomic status had undergone higher rates of oral cancer biopsy in PHC, which decreased the mean time to begin oral cancer treatment (Indirect effect, SFL = −0.041, p = 0.035). Health regions with a higher proportion of advanced-stage diagnoses tended to experience greater delays in treatment (Direct effect, SFL = 0.252, p = 0.001).

Conclusions

Findings suggest associations between PHC actions, socioeconomic conditions, and treatment timeliness across health regions, but the ecological design precludes causal inference and warrants caution due to ecological fallacy. These results underscore the need for individual-level studies to clarify links between early diagnosis and timely cancer care.