Department of Surgery, Rutgers-New Jersey Medical School, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, USA.
Clinical Outcomes Research Group, CORG LLC, 178 Meadow Brook Road, Grantham, NH, 03753, USA.
Updates Surg. 2019 Sep;71(3):523-531. doi: 10.1007/s13304-019-00632-5. Epub 2019 Feb 20.
Colorectal cancer, despite multiple screening measures being available, is the second leading cause of death due to cancer. Cancer stage at diagnosis is an important determinant of survival, where earlier stages have significantly increased rates of survival. By looking at various social health disparities (at a patient and geographic level) and their effect on stage at presentation, we will gain a better understanding of the effect they have on cancer outcomes. Data were collected from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database for the years 2007-2014. Covariates extracted were patient-level variables such as age, race, primary site, state/county, insurance status as well as county-level data which included percent urban population, median family income, rural-urban continuum code classification, percent of population that has not completed high school, percent of population below the poverty line, percent of population foreign-born, percent of language-isolated persons, and unemployment rate. The primary outcome analyzed was cancer staging at diagnosis. A χ analysis and multivariate binary logistic regression was modeled to elucidate the associations between study covariates and late stage of cancer presentation. Chi-squared analysis demonstrated significant associations (at p < 0.05) between stage of diagnosis with race, age, insurance status, location of primary site, percent of population below poverty line, percent of language-isolated persons, and percent of unemployed. To help reduce these disparities, community resources and increased screening and prevention techniques must be implemented to target the unique populations at greatest risk for developing the disease.
尽管有多种筛查措施可用，但结直肠癌仍是癌症死亡的第二大主要原因。诊断时的癌症分期是生存的重要决定因素，早期阶段的生存率显著提高。通过观察各种社会健康差异（在患者和地理层面）及其对表现分期的影响，我们将更好地了解它们对癌症结果的影响。数据来自国家癌症研究所监测、流行病学和最终结果 (SEER) 数据库，时间范围为 2007 年至 2014 年。提取的协变量包括患者层面的变量，如年龄、种族、原发部位、州/县、保险状况以及包括城市人口比例、家庭中位数收入、城乡连续体代码分类、未完成高中学业的人口比例、贫困人口比例、外国出生人口比例、语言隔离人口比例和失业率在内的县级数据。主要分析结果是诊断时的癌症分期。采用卡方分析和多变量二项逻辑回归模型来阐明研究协变量与癌症晚期表现之间的关联。卡方分析显示诊断分期与种族、年龄、保险状况、原发部位位置、贫困线以下人口比例、语言隔离人口比例和失业人口比例之间存在显著关联（p<0.05）。为了减少这些差异，必须实施社区资源和增加筛查和预防技术，以针对最有可能患上这种疾病的特定人群。
