Ortiz-Ortiz Karen J, Ríos-Motta Ruth, Marín-Centeno Heriberto, Cruz-Correa Marcia, Ortiz Ana Patricia
Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
BMC Health Serv Res. 2016 Aug 3;16(a):344. doi: 10.1186/s12913-016-1590-4.
Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico's Government Health Plan (GHP) patients.
We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study.
There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage.
These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient's pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
癌症诊断时处于晚期被认为是生存率较低的关键预测因素。了解和认识结直肠癌早期诊断的障碍对于减轻波多黎各癌症造成的社会和经济负担至关重要。本研究评估了波多黎各政府健康计划（GHP）患者中与结直肠癌诊断分期相关的因素。
我们基于二次数据分析进行了一项横断面研究，使用了来自波多黎各中央癌症登记处（PRCCR）和波多黎各健康保险管理局（PRHIA）的信息。采用逻辑回归模型估计未调整比值比（ORs）和调整比值比（AORs）及其95%置信区间（CIs）。研究纳入了2012年1月1日至2012年12月31日期间诊断为结直肠癌的50至64岁患者，这些患者是GHP的参与者且癌症诊断已报告给PRCCR。
68例（35.79%）结直肠癌患者在早期被诊断，而122例（64.21%）在晚期被诊断。在多变量分析中，诊断延迟超过59天（AOR 2.94，95% CI：1.32至6.52）以及首次通过急诊室就诊（AOR 3.48，95% CI：1.60至7.60）是晚期诊断为结直肠癌的有力预测因素。
这些结果对于理解影响GHP中结直肠癌患者结局的因素具有重要意义。因此，继续开展研究以了解政府健康计划患者的癌症诊断途径，从而促进做出果断决策以改善患者结局非常重要。
