Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China.
JMIR Public Health Surveill. 2023 Sep 5;9:e41999. doi: 10.2196/41999.
Patients with colorectal cancer (CRC) often present with multiple comorbidities, and many of these can affect treatment and survival. However, previous comorbidity studies primarily focused on diseases in commonly used comorbidity indices. The comorbid status of CRC patients with respect to the entire spectrum of chronic diseases has not yet been investigated.
This study aimed to systematically analyze all chronic diagnoses and diseases co-occurring, using a network-based approach and large-scale administrative health data, and provide a complete picture of the comorbidity pattern in patients newly diagnosed with CRC from southwest China.
In this retrospective observational study, the hospital discharge records of 678 hospitals from 2015 to 2020 in Sichuan Province, China were used to identify new CRC cases in 2020 and their history of diseases. We examined all chronic diagnoses using ICD-10 (International Classification of Diseases, 10th Revision) codes at 3 digits and focused on chronic diseases with >1% prevalence in at least one subgroup (1-sided test, P<.025), which resulted in a total of 66 chronic diseases. Phenotypic comorbidity networks were constructed across all CRC patients and different subgroups by sex, age (18-59, 60-69, 70-79, and ≥80 years), area (urban and rural), and cancer site (colon and rectum), with comorbidity as a node and linkages representing significant correlations between multiple comorbidities.
A total of 29,610 new CRC cases occurred in Sichuan, China in 2020. The mean patient age at diagnosis was 65.6 (SD 12.9) years, and 75.5% (22,369/29,610) had at least one comorbidity. The most prevalent comorbidities were hypertension (8581/29,610, 29.0%; 95% CI 28.5%-29.5%), hyperplasia of the prostate (3816/17,426, 21.9%; 95% CI 21.3%-22.5%), and chronic obstructive pulmonary disease (COPD; 4199/29,610, 14.2%; 95% CI 13.8%-14.6%). The prevalence of single comorbidities was different in each subgroup in most cases. Comorbidities were closely associated, with disorders of lipoprotein metabolism and hyperplasia of the prostate mediating correlations between other comorbidities. Males and females shared 58.3% (141/242) of disease pairs, whereas male-female disparities occurred primarily in diseases coexisting with COPD, cerebrovascular diseases, atherosclerosis, heart failure, or renal failure among males and with osteoporosis or gonarthrosis among females. Urban patients generally had more comorbidities with higher prevalence and more complex disease coexistence relationships, whereas rural patients were more likely to have co-existing severe diseases, such as heart failure comorbid with the sequelae of cerebrovascular disease or COPD.
Male-female and urban-rural disparities in the prevalence of single comorbidities and their complex coexistence relationships in new CRC cases were not due to simple coincidence. The results reflect clinical practice in CRC patients and emphasize the importance of measuring comorbidity patterns in terms of individual and coexisting diseases in order to better understand comorbidity patterns.
结直肠癌（CRC）患者常伴有多种合并症，其中许多合并症会影响治疗和生存。然而，以前的合并症研究主要集中在常用合并症指数中的疾病上。CRC 患者的合并症状态与整个慢性疾病谱尚未得到研究。
本研究旨在使用基于网络的方法和大规模的行政健康数据，系统地分析所有慢性诊断和共病，为中国西南地区新诊断为 CRC 的患者提供全面的共病模式。
在这项回顾性观察性研究中，我们使用了来自中国四川省 2015 年至 2020 年的 678 家医院的住院记录，以确定 2020 年新发生的 CRC 病例及其疾病史。我们使用 ICD-10（国际疾病分类，第 10 版）代码在 3 位数水平上检查所有慢性诊断，并关注至少一个亚组中患病率>1%的慢性疾病（单侧检验，P<.025），这总共导致了 66 种慢性疾病。通过性别、年龄（18-59、60-69、70-79 和≥80 岁）、地区（城市和农村）和癌症部位（结肠和直肠），为所有 CRC 患者和不同亚组构建表型共病网络，共病作为节点，连接代表多种共病之间的显著相关性。
2020 年在中国四川共发生 29610 例新 CRC 病例。患者诊断时的平均年龄为 65.6（SD 12.9）岁，75.5%（22369/29610）至少有一种合并症。最常见的合并症是高血压（8581/29610，29.0%；95%CI 28.5%-29.5%）、前列腺增生（3816/17426，21.9%；95%CI 21.3%-22.5%）和慢性阻塞性肺疾病（COPD；4199/29610，14.2%；95%CI 13.8%-14.6%）。在大多数情况下，每个亚组的单一合并症的患病率都不同。合并症密切相关，脂蛋白代谢紊乱和前列腺增生调节着其他合并症之间的相关性。男性和女性共享 58.3%（141/242）的疾病对，而男性和女性之间的差异主要发生在 COPD、脑血管疾病、动脉粥样硬化、心力衰竭或肾衰竭并存的疾病，以及女性的骨质疏松症或膝关节炎。城市患者通常有更多的合并症，且患病率更高，疾病共存关系更复杂，而农村患者更可能同时患有严重疾病，如心力衰竭合并脑血管病后遗症或 COPD。
CRC 新发病例中男性和女性、城市和农村在单一合并症的患病率以及其复杂的共存关系方面的差异并非简单的巧合。结果反映了 CRC 患者的临床实践，强调了衡量个体和共存疾病的合并症模式的重要性，以便更好地了解合并症模式。
