Kim Ki Bae, Shin Dong Wook, Yeob Kyoung Eun, Kim So Young, Han Joung-Ho, Park Seon Mee, Park Jong Heon, Park Jong Hyock
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, South Korea.
Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea.
World J Gastrointest Oncol. 2024 Jul 15;16(7):2925-2940. doi: 10.4251/wjgo.v16.i7.2925.
Little is known about disparities in diagnosis and treatment among colorectal cancer (CRC) patients with and without disabilities.
To investigate the patterns of diagnosis, treatment, and survival for people with and without disabilities who had CRC.
We performed a retrospective analysis using the Korean National Health Insurance Service database, disability registration data, and Korean Central Cancer Registry data. The analysis included 21449 patients with disabilities who were diagnosed with CRC and 86492 control patients diagnosed with CRC.
The overall distribution of CRC stage was not affected by disability status. Subjects with disabilities were less likely than those without disabilities to undergo surgery [adjusted odds ratio (aOR): 0.85; 95% confidence interval (95%CI): 0.82-0.88], chemotherapy (aOR: 0.84; 95%CI: 0.81-0.87), or radiotherapy (aOR: 0.90; 95%CI: 0.84-0.95). The rate of no treatment was higher in patients with disabilities than in those without disabilities (aOR: 1.48; 95%CI: 1.41-1.55). The overall mortality rate was higher in patients with disabilities [adjusted hazard ratio (aHR): 1.24; 95%CI: 1.22-1.28], particularly severe disabilities (aHR: 1.57; 95%CI: 1.51-1.63), than in those without disabilities.
Patients with severe disabilities tended to have a late or unknown diagnosis. Patients with CRC and disabilities had lower rates of treatment with almost all modalities compared with those without disabilities. During the follow-up period, the mortality rate was higher in patients with disabilities than in those without disabilities. The diagnosis and treatment of CRC need improvement in patients with disabilities.
关于患有和未患有残疾的结直肠癌（CRC）患者在诊断和治疗方面的差异，人们了解甚少。
调查患有和未患有残疾的CRC患者的诊断、治疗和生存模式。
我们使用韩国国民健康保险服务数据库、残疾登记数据和韩国中央癌症登记数据进行了一项回顾性分析。分析包括21449名被诊断患有CRC的残疾患者和86492名被诊断患有CRC的对照患者。
CRC分期的总体分布不受残疾状况的影响。与无残疾者相比，残疾患者接受手术的可能性较小[调整后的优势比（aOR）：0.85；95%置信区间（95%CI）：0.82 - 0.88]、化疗（aOR：0.84；95%CI：0.81 - 0.87）或放疗（aOR：0.90；95%CI：0.84 - 0.95）。残疾患者未接受治疗的比例高于无残疾者（aOR：1.48；95%CI：1.41 - 1.55）。残疾患者的总体死亡率较高[调整后的风险比（aHR）：1.24；95%CI：1.22 - 1.28]，尤其是重度残疾患者（aHR：1.57；95%CI：1.51 - 1.63），高于无残疾者。
重度残疾患者往往诊断较晚或诊断不明。与无残疾的CRC患者相比，患有残疾的CRC患者几乎所有治疗方式的治疗率都较低。在随访期间，残疾患者的死亡率高于无残疾者。CRC在残疾患者中的诊断和治疗需要改进。
