Impact of residential proximity to hospital on diagnostic inequality: A retrospective analysis from Central Poland

Abstract

Introduction: Access to oncology care in Poland remains uneven, with rural residents limited to specialist availability. We analyzed geographic factors that may worsen cancer outcomes and deepen health disparities in Poland between rural and urban inhabitants. Objectives: This study aims to evaluate the impact of geographic and demographic factors on cancer diagnosis in central Poland, focusing on disparities between urban and rural populations.

Methods: A retrospective cohort analysis was conducted on 4,771 patients suspected of having cancer at the Nikolay Pirogov Specialized District Hospital in Łódź between 2020 and 2024. Clinical records and public health datasets were analyzed. Logistic regression was used to assess associations between cancer diagnosis and variables such as distance to the nearest hospital, residence type (urban vs. rural), age, and sex. Models were adjusted for potential confounders.

Results: Of the 4,771 patients evaluated, 2,996 (62.8%) received a cancer diagnosis and 1,775 (37.2%) did not. In multivariable models, living 5–10 km from the hospital (vs. <5 km) was associated with higher odds of confirmed diagnosis, while residence types were not independently associated with diagnosis. We explicitly limited inference to individuals who ultimately accessed hospital care.

Conclusion: Geographic accessibility showed a localized association within the 5–10 km band, whereas residence >10 km and urban/rural status did not demonstrate independent effects after adjustment. These findings are hypothesis-generating and should be interpreted as indicators of potential access pathways among hospital-admitted patients, rather than causal effects. Targeted interventions (e.g., mobile diagnostics, transportation support, and optimized referral pathways) warrant evaluation.

Keywords

Cancer treatment initiation / Cancer diagnosis / Distance to hospital / Urban–rural disparities / Healthcare accessibility

Acknowledgements

Manuscript preparation was supported during Harvard Medical School’s Polish Clinical Scholars Research Training Program, organized by the Medical Research Agency (Agencja Badan Medycznych, Warsaw, Poland).

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: All authors

Formal analysis: Anna Skotny

Methodology: Anna Skotny

Writing–original draft: Anna Skotny

Writing–review & editing: Paulina Podlawska-Nowak

Ethics approval and consent to participate

This study was conducted using anonymized clinical data collected from patients evaluated at the Nikolay Pirogov Specialized District Hospital in Łódź, Poland. Approval to use these data for scientific purposes was granted by the hospital administration on October 28, 2024. The approval includes access to medical records containing information on diagnoses, addictions, comorbidities, age at the time of hospitalization, medications used, and patients’ medical history over the past five years. All data were fully anonymized before analysis, and no personally identifiable information-such as names, national identification numbers, addresses, or contact details-was included.

Consent for publication

Not applicable.

Availability of data

The anonymized data that support the findings of this study are available from the corresponding author upon reasonable request supported by consent of the local Ethics Committee.

References

[1] Statistics Poland. Population. Size and Structure and Vital Statistics in Poland by Territorial Division in 2023. As of 31 December. Warsaw: Statistics Poland; 2023. Available from: https://stat.gov.pl/obszary-tematyczne/ludnosc/ludnosc/ludnosc-stan-i-struktura-ludnosci-oraz-ruch-naturalny-w-przekroju-terytorialnym-w-2023-r-stan-w-dniu-31-12%2C6%2c36.html [Last accessed on 2025 Jun 28].

[2] Instytut Praw Pacjenta i Opieki Zdrowotnej. Walka z Nierównościami w Dostępie do Opieki Zdrowotnej; 2023. Available from: https://ippez.pl/walka-z-nierownosciami-w-dostepie-do-opieki-zdrowotnej [Last accessed on 2025 Jun 28].

[3] Fundacja Polska Koalicja Pacjentów Onkologicznych. Raport; 2024. Available from: https://www.pkpo.pl/wspolpraca/raporty-i-poradniki [Last accessed on 2025 Jun 28].

[4] Organisation for Economic Co-Operation and Development (OECD). Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023. p. 103. Available from: https://www.oecd.org/content/dam/oecd/en/publications/reports/2023/11/health-at-a-glance-2023_e04f8239/7a7afb35-en.pdf [Last accessed on 2025 Jun 28].

[5] Oncoindex. Polska - Dla Eksperta; 2023. Available from: https://oncoindex.org/pl/polska/dla-eksperta [Last accessed on 2025 Jun 28].

[6] Narodowy Fundusz Zdrowia. Programy Lekowe; 2025. Available from: https://gsl.nfz.gov.pl/gsl/gsl/programylekowe [Last accessed on 2025 Jun 28]

[7] Van Poppel H, Battisti NML, Lawler M, et al. European cancer organisation’s inequalities network: Putting cancer inequalities on the European policy map. JCO Glob Oncol. 2022; 8: e2200233. doi: 10.1200/go.22.00233

[8] Coppini V, Ferraris G, Ferrari MV, et al. Patients’ perspectives on cancer care disparities in Central and Eastern European countries: Experiencing taboos, misinformation and barriers in the healthcare system. Front Oncol. 2024; 14: 1420178. doi: 10.3389/fonc.2024.1420178

[9] Levit LA, Byatt L, Lyss AP, et al. Closing the rural cancer care gap: Three institutional approaches. JCO Oncol Pract. 2020; 16(7): 422-430. doi: 10.1200/op.20.00174

[10] Zahnd WE, James AS, Jenkins WD, et al. Rural-urban differences in cancer incidence and trends in the United States. Cancer Epidemiol Biomarkers Prev. 2018; 27(11): 1265-1274. doi: 10.1158/1055-9965.epi-17-0430

[11] Afshar N, English DR, Milne RL. Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer. 2019; 125(13): 2172-2184. doi: 10.1002/cncr.32073

[12] Cancer in Poland 2022. Health Ministry, National Institute in Oncology, National Cancer Registry, Publicagion Warsaw; 2024. Available from: https://onkologia.org.pl/sites/default/files/publications/2025-02/nowotwory_2022.pdf [Last accessed on 2025 Nov 20].