Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK.
Int J Environ Res Public Health. 2021 Jan 25;18(3):1052. doi: 10.3390/ijerph18031052.
A patient's survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients' central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services.
患者的生存可能取决于几个已知和未知的因素，并且在一个区域内也可能存在空间差异。社会经济地位、获得医疗保健的机会和其他环境因素可能会影响生存率。本研究的目的是针对马来西亚结直肠癌患者，建立考虑个体和社会经济风险因素的生存空间变异模型。我们对 2008 年至 2013 年间诊断的 4412 例结直肠癌（ICD-10，C18-C20）患者进行了回顾性研究，以建立 CRC 患者的生存模型。我们使用马来西亚国家癌症患者登记处-结直肠癌数据库中记录的数据（NCPR-CRC）。空间位置是根据患者的中心区位置分配的，涉及马来西亚的 144 个行政区。我们拟合了一个参数比例风险模型，其中空间相关的脆弱性通过对数高斯随机过程进行建模，以分析空间参考生存数据，这也称为空间生存模型。在控制个体和区域特征后，我们的研究结果表明，马来西亚的结直肠癌生存率存在广泛的空间差异。患者居住地区更好的医疗保健提供和更高的社会经济指数降低了死于结直肠癌的风险，但这些关联没有统计学意义。需要可靠地测量环境因素，以深入了解疾病潜在风险因素的影响。例如，需要更好的指标来衡量该国的社会经济地位和获得医疗保健的机会。研究结果提供了新的信息，可能有助于卫生部识别生存率较差风险较高的人群，并为癌症控制服务的规划和提供提供参考。
