{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T19:36:55Z","timestamp":1787254615393,"version":"build-2736575974"},"reference-count":46,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T00:00:00Z","timestamp":1722643200000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012659","name":"Canadian Centre for Applied Research in Cancer Control","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective cohort study of colon cancer patients diagnosed 2007\u20132019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low\u2010income neighborhoods was associated with longer 50th and 90th\u2010percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15\u2009days (95% CI 6\u201323) longer in patients living in the lowest income neighborhoods compared to the highest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6999","type":"journal-article","created":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T07:55:21Z","timestamp":1722671721000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Income differences in time to colon cancer diagnosis"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5236-2703","authenticated-orcid":false,"given":"Laura E.","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"ICES  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin C.","family":"Strumpf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University  Montreal Canada"},{"name":"Department of Economics McGill University  Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery Queen's University  Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6862-3760","authenticated-orcid":false,"given":"Alyson L.","family":"Mahar","sequence":"additional","affiliation":[{"name":"ICES  Toronto Canada"},{"name":"School of Nursing Queen's University  Kingston Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.9412"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2208375"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4087"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0126608"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2017.236"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2012.68"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0127717"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-023-01829-2"},{"key":"e_1_2_12_10_1","volume-title":"Reducing Social Inequalities in Cancer: Evidence and Priorities for Research","author":"International Agency for Research on Cancer","year":"2019"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33107"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2020.1772501"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-020-03585-z"},{"key":"e_1_2_12_14_1","article-title":"Factors contributing to time to diagnosis in symptomatic colorectal cancer: a scoping review","volume":"30","author":"Golding H","year":"2020","journal-title":"Eur J Cancer Care (Engl)"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.30"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12483"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1944-y"},{"key":"e_1_2_12_18_1","first-page":"246","volume-title":"Cancer Registration Principles and Methods","author":"Clarke E","year":"1991"},{"key":"e_1_2_12_19_1","volume-title":"Canadian Institute for Health Information Discharge Abstract Database: a Validation Study","author":"Juurlink D","year":"2006"},{"issue":"2","key":"e_1_2_12_20_1","first-page":"97","article-title":"The National Ambulatory Care Reporting System: factors that affect the quality of its emergency data","volume":"2","author":"Gibson D","year":"2008","journal-title":"Int J Inf Qual"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-8-79"},{"key":"e_1_2_12_22_1","volume-title":"Trends in Income\u2010Related Health Inequalities in Canada [Internet]","author":"CIHI","year":"2015"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25427"},{"key":"e_1_2_12_24_1","unstructured":"WilkinsR.PCCF + version 3G users guide: automated geographic coding based on the statistics Canada postal code conversion files. 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