Cohort study to assess geographical variation in cholangiocarcinoma treatment in England

Table 2 Estimated percentage of cholangiocarcinoma patients in England 2014-2017 that received

	A: Potentially curative surgery				B: Systemic therapy in those who did not receive surgery				C: Stent insertion in those who did not receive surgery
	Unadjusted		Adjusted		Unadjusted		Adjusted		Unadjusted		Adjusted
	Estimate (95%CI)		Estimate 95%CI		Estimate (95%CI)		Estimate 95%CI		Estimate (95%CI)		Estimate 95%CI
Population average (intercept)	12.45	(11.76, 13.14)	12.45	(11.81, 13.09)	19.89	(19.01, 20.78)	19.89	(19.1, 20.69)	27.82	(26.85, 28.78)	27.82	(26.85, 28.78)
Cheshire and Merseyside	3.71	(0.32, 7.10)	3.77	(0.54, 6.99)	-1.18	(-5.13, 2.78)	-0.09	(-3.88, 3.70)	2.35	(-2.29, 6.99)	3.50	(-1.15, 8.16)
East Midlands	-0.88	(-3.00, 1.25)	-1.11	(-3.10, 0.87)	-0.12	(-2.93, 2.69)	-0.60	(-3.14, 1.93)	-1.93	(-5.02, 1.16)	-2.43	(-5.45, 0.60)
East of England - North	-3.67	(-6.05, -1.29)	-3.96	(-6.34, -1.59)	0.82	(-2.70, 4.34)	-0.06	(-3.17, 3.04)	13.40	(9.15, 17.65)	11.59	(7.44, 15.74)
East of England - South	2.25	(-0.59, 5.08)	1.33	(-1.36, 4.01)	-1.62	(-4.99, 1.76)	-2.70	(-5.68, 0.29)	9.79	(5.59, 13.98)	10.26	(6.14, 14.38)
Greater Manchester	0.60	(-2.20, 3.41)	-1.32	(-3.93, 1.29)	-0.03	(-3.59, 3.54)	0.86	(-2.38, 4.09)	0.88	(-3.16, 4.92)	-2.48	(-6.37, 1.40)
Humber, Coast and Vale	0.78	(-2.93, 4.49)	2.14	(-1.29, 5.58)	-0.56	(-5.21, 4.09)	0.78	(-3.33, 4.88)	-10.72	(-15.18, -6.25)	-10.32	(-14.62, -6.03)
Kent and Medway	-2.49	(-6.16, 1.19)	-2.14	(-5.75, 1.47)	-0.87	(-5.93, 4.19)	-0.77	(-5.43, 3.88)	3.60	(-2.38, 9.58)	4.51	(-1.43, 10.44)
Lancashire and South Cumbria	1.19	(-2.45, 4.82)	1.63	(-1.72, 4.98)	2.21	(-2.52, 6.94)	2.43	(-1.74, 6.60)	1.66	(-3.54, 6.86)	3.18	(-1.90, 8.25)
North Central London	3.16	(-2.84, 9.15)	2.36	(-3.22, 7.94)	9.52	(1.30, 17.73)	9.28	(1.76, 16.80)	3.28	(-5.08, 11.63)	3.18	(-4.95, 11.32)
North East London	0.85	(-4.19, 5.89)	-0.05	(-4.79, 4.69)	6.77	(-0.28, 13.82)	5.93	(-0.41, 12.26)	9.52	(1.80, 17.23)	10.48	(2.89, 18.06)
North West and South West London	3.19	(-0.48, 6.87)	2.68	(-0.79, 6.15)	7.26	(2.35, 12.17)	6.23	(2.02, 10.43)	-3.97	(-8.70, 0.75)	-3.16	(-7.84, 1.53)
Northern	-0.28	(-2.58, 2.02)	-0.10	(-2.20, 2.00)	2.40	(-0.71, 5.51)	2.52	(-0.35, 5.40)	-9.82	(-12.74, -6.90)	-9.63	(-12.58, -6.69)
Peninsula	1.64	(-1.87, 5.15)	1.72	(-1.43, 4.87)	-1.24	(-5.50, 3.01)	-0.01	(-3.76, 3.75)	5.95	(0.80, 11.09)	6.65	(1.64, 11.66)
Somerset, Wiltshire, Avon and Gloucestershire	-2.14	(-5.00, 0.73)	-1.37	(-4.02, 1.29)	-2.51	(-6.28, 1.25)	-1.97	(-5.34, 1.41)	8.82	(4.07, 13.57)	8.87	(4.14, 13.59)
South East London	1.05	(-4.19, 6.28)	2.51	(-2.6, 7.62)	2.09	(-4.74, 8.92)	3.20	(-2.82, 9.23)	-2.28	(-9.48, 4.91)	-2.08	(-9.08, 4.91)
South Yorkshire and Bassetlaw	-0.22	(-4.43, 3.98)	1.66	(-2.28, 5.59)	-7.46	(-12.01, -2.91)	-3.84	(-8.04, 0.35)	-1.45	(-7.49, 4.59)	-3.75	(-9.79, 2.29)
Surrey and Sussex	-3.02	(-5.56, -0.48)	-3.79	(-6.27, -1.30)	1.37	(-2.33, 5.07)	-0.76	(-4.14, 2.61)	13.59	(9.15, 18.02)	13.64	(9.22, 18.06)
Thames Valley	A1.23	(-3.13, 5.58)	0.07	(-3.96, 4.10)	4.36	(-1.49, 10.21)	2.00	(-3.52, 7.52)	-9.50	(-14.81, -4.19)	-8.26	(-13.63, -2.89)
Wessex	-0.66	(-3.49, 2.17)	-0.36	(-2.99, 2.27)	-0.32	(-4.02, 3.38)	-1.55	(-4.89, 1.80)	-1.09	(-5.21, 3.04)	-0.29	(-4.30, 3.72)
West Midlands	0.39	(-1.55, 2.32)	1.48	(-0.33, 3.29)	-4.49	(-6.77, -2.22)	-3.31	(-5.39, -1.24)	-11.73	(-14.08, -9.39)	-10.54	(-12.88, -8.20)
West Yorkshire and Harrogate	-2.15	(-5.20, 0.90)	-2.47	(-5.40, 0.46)	-0.26	(-4.45, 3.94)	-0.71	(-4.35, 2.92)	-4.86	(-9.31, -0.40)	-6.69	(-10.88, -2.50)
Age 0-44	22.14	(15.21, 29.08)	20.69	(13.91, 27.47)	37.29	(28.28, 46.31)	36.41	(27.47, 45.35)	-1.37	(-9.44, 6.70)	-1.59	(-9.41, 6.24)
Age 45-54	15.07	(11.03, 19.11)	13.24	(9.38, 17.11)	30.34	(24.98, 35.70)	28.96	(23.77, 34.15)	-4.91	(-9.47, -0.34)	-5.80	(-10.26, -1.34)
Age 55-64	9.38	(7.31, 11.46)	7.59	(5.58, 9.61)	23.18	(20.34, 26.03)	21.61	(18.82, 24.40)	-0.07	(-2.73, 2.59)	-0.39	(-3.00, 2.21)
Age 65-74	6.11	(4.86, 7.36)	4.84	(3.64, 6.04)	10.60	(8.94, 12.26)	9.59	(7.97, 11.21)	1.47	(-0.27, 3.21)	1.75	(0.06, 3.44)
Age 75-84	-5.41	(-6.29, -4.53)	-4.83	(-5.69, -3.96)	-8.88	(-9.95, -7.81)	-8.68	(-9.73, -7.63)	1.49	(0.07, 2.90)	1.53	(0.16, 2.90)
Age 85+	-12.21	(-12.9, -11.52)	-9.55	(-10.28, -8.83)	-19.18	(-20.05, -18.30)	-17.16	(-18.08, -16.23)	-2.81	(-4.6, -1.01)	-2.83	(-4.64, -1.02)
Female	-1.81	(-2.49, -1.13)	-0.49	(-1.13, 0.16)	-0.30	(-1.16, 0.56)	1.21	(0.43, 2.00)	-1.09	(-2.05, -0.12)	-1.18	(-2.13, -0.24)
Male	1.88	(1.17, 2.58)	0.51	(-0.16, 1.18)	0.33	(-0.60, 1.26)	-1.32	(-2.16, -0.47)	1.18	(0.13, 2.22)	1.28	(0.25, 2.31)
Income deprivation quintile 1 (least deprived)	2.12	(0.63, 3.61)	2.04	(0.64, 3.43)	3.15	(1.22, 5.08)	3.17	(1.41, 4.92)	0.98	(-1.11, 3.08)	0.47	(-1.59, 2.52)
Income deprivation quintile 2	1.23	(-0.15, 2.61)	1.17	(-0.11, 2.45)	1.44	(-0.34, 3.22)	1.88	(0.29, 3.47)	1.07	(-0.91, 3.04)	0.30	(-1.60, 2.20)
Income deprivation quintile 3	-0.90	(-2.24, 0.43)	-0.21	(-1.47, 1.05)	-0.21	(-1.96, 1.54)	0.24	(-1.32, 1.79)	1.14	(-0.85, 3.13)	0.66	(-1.26, 2.59)
Income deprivation quintile 4	-0.50	(-1.84, 0.85)	-0.38	(-1.63, 0.88)	-2.53	(-4.23, -0.84)	-2.32	(-3.85, -0.79)	-0.98	(-2.93, 0.98)	-1.08	(-2.98, 0.82)
Income deprivation quintile 5 (most deprived)	-2.03	(-3.38, -0.68)	-2.77	(-4.10, -1.43)	-1.70	(-3.48, 0.07)	-2.91	(-4.59, -1.22)	-2.28	(-4.28, -0.27)	-0.34	(-2.33, 1.65)
Diagnosis year 2014	-0.16	(-1.41, 1.08)	0.49	(-0.67, 1.65)	-1.46	(-3.05, 0.12)	0.08	(-1.35, 1.50)	-1.85	(-3.64, -0.06)	-1.81	(-3.53, -0.09)
Diagnosis year 2015	-0.64	(-1.81, 0.54)	-0.48	(-1.57, 0.61)	-0.77	(-2.29, 0.75)	-0.56	(-1.93, 0.81)	-0.55	(-2.27, 1.16)	-0.29	(-1.95, 1.36)
Diagnosis year 2016	-0.24	(-1.42, 0.93)	-0.30	(-1.41, 0.80)	0.69	(-0.85, 2.22)	0.08	(-1.29, 1.46)	0.82	(-0.90, 2.53)	1.04	(-0.62, 2.69)
Diagnosis year 2017	1.00	(-0.19, 2.20)	0.32	(-0.79, 1.43)	1.41	(-0.14, 2.95)	0.39	(-0.99, 1.77)	1.42	(-0.31, 3.14)	0.88	(-0.77, 2.53)
Adenomas and adenocarcinomas	0.23	(0.14, 0.32)	0.24	(0.14, 0.35)	0.49	(0.38, 0.59)	0.23	(0.10, 0.36)	-0.04	(-0.23, 0.15)	0.40	(0.18, 0.61)
Other morphology	-6.82	(-9.54, -4.10)	-7.35	(-10.55, -4.16)	-13.58	(-16.57, -10.59)	-6.38	(-10.05, -2.72)	1.08	(-4.31, 6.48)	-11.15	(-17.12, -5.18)
eCCA sub-type	12.40	(10.56, 14.23)	12.34	(10.58, 14.10)	1.64	(-0.50, 3.78)	2.89	(0.92, 4.87)	19.07	(16.51, 21.62)	19.28	(16.7, 21.86)
iCCA sub-type	-2.35	(-2.78, -1.93)	-2.65	(-3.09, -2.22)	0.10	(-0.35, 0.55)	-0.47	(-0.92, -0.02)	-3.66	(-4.20, -3.13)	-3.89	(-4.47, -3.31)
Other sub-type	-9.17	(-11.00, -7.33)	-3.70	(-6.01, -1.38)	-6.74	(-10.12, -3.36)	-1.52	(-4.98, 1.94)	-0.62	(-5.01, 3.78)	2.37	(-2.50, 7.24)
Emergency presentation diagnosis route	-5.45	(-6.14, -4.76)	-3.75	(-4.42, -3.08)	-7.95	(-8.80, -7.09)	-5.31	(-6.11, -4.51)	1.52	(0.55, 2.49)	2.10	(1.14, 3.07)
GP referral diagnosis route	6.16	(4.65, 7.68)	4.61	(3.17, 6.05)	6.10	(4.15, 8.04)	4.18	(2.39, 5.97)	-4.60	(-6.54, -2.65)	-5.28	(-7.16, -3.40)
IP and OP diagnosis route	13.04	(10.54, 15.55)	9.44	(7.09, 11.79)	12.54	(9.35, 15.73)	7.65	(4.69, 10.61)	-2.76	(-5.77, 0.25)	-2.75	(-5.69, 0.18)
TWW referral diagnosis route	-0.14	(-1.66, 1.37)	-0.58	(-2.08, 0.91)	10.96	(8.75, 13.18)	8.57	(6.55, 10.59)	2.92	(0.65, 5.19)	2.29	(0.06, 4.51)
Unknown diagnosis route	-2.99	(-7.06, 1.07)	-3.21	(-6.51, 0.08)	-5.61	(-10.73, -0.49)	-8.05	(-11.96, -4.15)	-5.21	(-11.31, 0.89)	-5.94	(-11.07, -0.81)
Charlson score - 0	1.69	(1.28, 2.10)	0.69	(0.30, 1.09)	3.19	(2.65, 3.73)	1.02	(0.51, 1.53)	1.52	(0.86, 2.18)	1.38	(0.73, 2.04)
Charlson score - 1	-2.31	(-3.98, -0.64)	-0.28	(-1.85, 1.29)	-3.40	(-5.56, -1.25)	0.42	(-1.52, 2.37)	-1.73	(-4.26, 0.80)	-2.00	(-4.45, 0.45)
Charlson score - 2	-4.32	(-6.35, -2.29)	-2.06	(-3.96, -0.17)	-6.06	(-8.71, -3.40)	-0.81	(-3.25, 1.63)	-1.97	(-5.30, 1.35)	-1.77	(-4.94, 1.40)
Charlson score - 3+	-6.07	(-7.74, -4.39)	-3.19	(-4.79, -1.60)	-12.84	(-14.71, -10.97)	-7.06	(-8.93, -5.20)	-6.73	(-9.52, -3.93)	-5.53	(-8.33, -2.74)
Liver disease-no	-0.73	(-0.99, -0.47)	-0.35	(-0.60, -0.10)	-0.51	(-0.80, -0.21)	0.04	(-0.25, 0.32)	0.46	(0.17, 0.75)	0.38	(0.10, 0.67)
Liver disease-yes	7.23	(4.65, 9.82)	3.47	(0.96, 5.97)	5.53	(2.33, 8.73)	-0.43	(-3.55, 2.69)	-4.99	(-8.11, -1.86)	-4.19	(-7.29, -1.08)

Apart from the intercept, estimates represent the percentage-point difference from the weighted cohort average probability of each route. CI: Confidence interval; iCCA: Intrahepatic cholangiocarcinoma; eCCA: Extrahepatic cholangiocarcinoma; GP: General Practitioner; IP: Inpatient; OP: Outpatient; TWW: Two week wait.