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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Disparities in the diagnosis and treatment of colorectal cancer among patients with disabilities
Ki Bae Kim, Dong Wook Shin, Kyoung Eun Yeob, So Young Kim, Joung-Ho Han, Seon Mee Park, Jong Heon Park, Jong Hyock Park
Ki Bae Kim, Joung-Ho Han, Seon Mee Park, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju 28644, South Korea
Dong Wook Shin, Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Dong Wook Shin, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, South Korea
Kyoung Eun Yeob, So Young Kim, Jong Hyock Park, Institute of Health & Science Convergence, Chungbuk National University, Cheongju 28644, South Korea
So Young Kim, Jong Hyock Park, Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju 28644, South Korea
Jong Heon Park, Big Data Steering Department, National Health Insurance Service, Wonju 26464, South Korea
Jong Hyock Park, College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju 28644, South Korea
Jong Hyock Park, Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju 28644, South Korea
Co-first authors: Ki Bae Kim and Dong Wook Shin.
Author contributions: Kim KB, Shin DW, and Park JH contributed to study concept and design; Park JH, Yeob KE, Park JH, and Kim SY contributed to acquisition of data; Kim KB, Shin DW, Yeob KE, Han JH, Park SM, Park JH, Park JH, and Kim SY contributed to analysis and interpretation of data; Kim KB, Shin DW, and Yeob KE contributed to drafting of the manuscript; Yeob KE and Park JH contributed to statistical analysis; Park JH contributed to obtaining funding; and all of the authors have read and approved the final manuscript.
Supported by the R&D grant from the Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, No. 2016007; and Grants from the National Research Foundation of Korea (NRF) funded by the Ministry of Education, No. 2022R1I1A1A01068449 and No. 2022R1I1A3070074.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Chungbuk National University (Approval No. CBNU-201709-BM-0113).
Informed consent statement: This research presents no more than minimal risk of harm to subjects and involves no procedures for which written consent is normally required outside the research context. We were using secondary data (open data).
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jong Hyock Park, PhD, Professor, College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, South Korea. jonghyock@gmail.com
Received: January 15, 2024
Revised: March 28, 2024
Accepted: April 30, 2024
Published online: July 15, 2024
Processing time: 179 Days and 15.1 Hours
BACKGROUND
Little is known about disparities in diagnosis and treatment among colorectal cancer (CRC) patients with and without disabilities.
AIM
To investigate the patterns of diagnosis, treatment, and survival for people with and without disabilities who had CRC.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Core Tip: Little is known about disparities in diagnosis, treatment, and survival among colorectal-cancer patients with and without disabilities. The overall distribution of colorectal cancer (CRC) stage was not affected by disability status. But disability affected the timing of diagnosis, treatment, and mortality, and this trend was more severe in cases of severe disability. Further research is needed to develop guidelines to ensure equal diagnosis and treatment of CRC in disabled and non-disabled patients.
