Bibliographic record
Abstract
Introduction: In Ontario, Canada (population 14.7 million), robotic-assisted radical prostatectomies (RARP) are predominantly performed in larger academic centers and urban hospitals, potentially leading to disparities in access across the province.Given the concentration of RARP resources in these centers, patients from rural or marginalized communities may face increased travel burdens and reduced availability of RARP, impacting equitable access to prostate cancer surgery, despite a universal publicly insured health system.This study assessed the impact of socioeconomic marginalization on access to RARP vs. open radical prostatectomy (ORP) for localized prostate cancer in Ontario, Canada, from April 1, 2017, to March 31, 2024.Methods: This retrospective cohort study included all Ontario patients who underwent Quality Based Procedures-funded radical prostatectomy for localized prostate cancer during the study period.Patient socioeconomic status was assessed using the 2021 Ontario Marginalization Index, which includes income, education, housing, and family structure.This database is based on Canadian census dissemination areas -small geographic units averaging 400-700 people.Other equity-related outcomes included neighborhood income quintiles, rurality, and distance from home to hospital.Results: We identified 6645 RARP cases and 8428 ORP cases, with RARP representing 35.1% of cases in 2017, increasing to 56.2% by 2023.The median distance traveled to hospital was 23.1 km for RARP cases (IQR 8-58) and 11.9 km for ORP (IQR 5-30).RARP cases waited longer, on average, for surgery (mean 73 days, SD 51) compared to ORP (mean 42 days, SD 32), with only 57% of RARP cases within their wait time target as compared to 81% of ORP patients.Both RARP and ORP were similarly distributed among patients residing in urban (87%) and rural (13%) areas.A gradient was observed by material resource marginalization quintiles (Q); patients in higher-marginalization neighborhoods had reduced RARP access (27% in Q1 vs. 14% in Q5), whereas ORP showed less disparity (24% in Q1 vs. 15% in Q5).Similarly, RARP access was higher in affluent areas (30% in highest-income quintile vs. 14% in lowest), while ORP varied less by income (24% highest vs. 15% lowest).Conclusions: This study found fewer RARP procedures among patients residing in highly marginalized and low-income neighborhoods, suggesting a disparity in access to RARP, despite improving access to RARP across the province.Further research is needed to explore the intersectional factors that may contribute to this gradient and its impact on clinical outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.448 | 0.118 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".