Merga Bedasa Taye, McCaffrey Nikki, Robinson Suzanne, Sinclair Craig, Yeung Justin M, Lal Anita
School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Oromia, Ethiopia.
Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.
Cancer Med. 2025 May;14(9):e70909. doi: 10.1002/cam4.70909.
Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia.
Linked datasets from a Victorian population-based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a p-value threshold < 0.05.
A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty-one per cent (5086) of them reported CRC-related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = -0.060, p-value < 0.001) and regional and remote areas (CI = -0.065, p-value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced-stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45-49 age groups (65-69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70).
Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.
癌症护理可及性和利用率的差异会影响诊断阶段和护理途径。以急诊形式就诊的结直肠癌(CRC)患者往往病情已发展至晚期,预后较差。本研究旨在评估澳大利亚维多利亚州CRC患者急诊就诊(EP)的地理和社会经济差异。
分析了来自维多利亚州基于人群的癌症登记处以及急诊和医院入院记录的关联数据集,纳入2009年至2022年期间确诊的CRC患者。集中指数(CI)评估了按社会经济地位和偏远程度划分的EP分布情况。多变量逻辑回归确定了与EP相关的因素,结果以调整后的比值比和95%置信区间呈现。在所有分析中,使用p值阈值<0.05来确定统计学显著性。
共有24236名CRC患者因任何原因前往急诊科就诊。其中21%(5086名)报告有CRC相关症状。在这些患者中,33.8%(1721名)在诊断前6个月内就诊。集中指数表明,在最贫困的五分之一人群中(CI = -0.060,p值<0.001)以及在地区和偏远地区(CI = -0.065,p值<0.001),EP比例过高。多变量逻辑回归显示,与最不贫困人群(Q5)相比,社会经济弱势群体中EP的几率更高(Q1:调整后的比值比[AOR]=1.25;Q2:AOR = 1.31)。同样,地区和偏远地区的患者发生EP的几率高于大城市的患者(内地区域:AOR = 1.26;外地区域/偏远地区:AOR = 1.52)。与早期诊断相比,晚期诊断的几率更高(4期:AOR = 1.67),而与45 - 49岁年龄组相比,老年组的几率较低(65 - 69岁:AOR = 0.67,≥75岁,AOR = 0.60至0.70)。
加强初级保健服务的可及性并强化癌症筛查项目,特别是在社会经济弱势群体以及地区和偏远社区,可减少差异,促进早期诊断并改善预后。对这些人群优先进行有针对性的干预对于解决这些不平等问题至关重要。