HERO On line Working Paper Series
The Importance of Municipality Characteristics for Cancer Survival in Norway: A Multilevel Analysis
Abstract: Discrete-time hazard models for cancer mortality in cancer
patients were estimated from register and census data to find out whether
various socio-economic, ideational and institutional community factors had
an impact on cancer survival in Norway in the 1990s, also beyond that of
the corresponding individual-level variables. Such a multilevel approach
has not been employed in previous analyses of cancer survival. In addition
to confirming the better prognosis for patients with high education, it was
found that, among patients at the same educational level, mortality was
lowest for those who lived in a municipality where the average education
was relatively high. The impact of economic resources was less pronounced.
While a low unemployment rate in the municipality and high individual
income reduced mortality among cancer patients, a high average income had
no effect. Also those who lived in municipalities where a large proportion
voted with the Christian Democratic Party had an advantage, which suggests
a beneficial impact of affiliation with religious communities or support
for the central Christian ideas. Moreover, there was an excess mortality
among patients who lived in municipalities served by a relatively small
hospital that did not have any responsibility beyond the county level.
These patients may have got somewhat inadequate treatment at a low level in
the hospital structure, or they have perhaps not wanted, or been able to
fully comply with, the recommended follow-up treatment at the highest
level. Even with such factors included in the model, there was significant
regional variation. Cancer survival was relatively poor, net of differences
in the stage distribution, in the capital, the central parts of Southern
and Western Norway, and the peripheral parts of Southern Norway.
Keywords: Cancer; Hospital; Multilevel; Region; Socio-economic; Survival; Education; Income; Religion; Unemployment; (follow links to similar papers)
JEL-Codes: I19; (follow links to similar papers)
18 pages, June 14, 2009
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