Accessibility as a major determinant of radiotherapy underutilization: A population based study

Eva Pagano, Daniela Di Cuonzo, Cristina Bona, Ileana Baldi, Pietro Gabriele, Umberto Ricardi, Paolo Rotta, Oscar Bertetto, Silvana Appiano, Franco Merletti, Nereo Segnan, Giovannino Ciccone

Research output: Contribution to journalArticlepeer-review


Background and purpose: A survey was conducted of radiotherapy (RT) resources and utilization in a northwestern Italian Region in order to assess geographical variations in radiotherapy utilization rates, and the effects of infrastructure supply on accessibility. Materials and methods: The survey was conducted by analysing standardized utilization rates based on administrative records. The data were analysed at both Regional and Local Health Unit (LHU) level. Results: Wide variation was found among LHUs RT utilization rates-the sex- and age-standardized rates varied from 1.8/1000 inhabitants to more than 3/1000 inhabitants. Patients resident in LHUs with no RT service showed a lower probability of accessing RT (standardized rate ratio (SRR), 0.82; 95%IC, 0.80-0.85). The utilization rate decreased in relation to the distance between a patient's residence and the nearest RT service; the reduction was greater for patients ≥70 years of age. Conclusion: The wide geographic variation implies lack of equity in access to services. Utilization levels decreased significantly with increasing distance from the nearest RT service, distance being a barrier to access particularly for older persons. The heterogeneous distribution of services on the Regional territory seems a relevant explanation of differences in utilization rates.

Original languageEnglish
Pages (from-to)483-491
Number of pages9
JournalHealth Policy
Issue number3
Publication statusPublished - Mar 2007


  • Health care surveys
  • Health services accessibility
  • Needs assessment
  • Radiotherapy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy


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