Disparities in the diagnosis and treatment of colorectal cancer among patients with disabilities

Table 1 Characteristics of colorectal cancer patients with and without disabilities, n (%)

	People without disabilities	People with disability	By disability grade		By disability type
			Grades 1-3	Grades 4-6	Physical	Communication	Brain	Mental	Cardiopulmonary	Others
All subject, n	81069	19664	6517	13147	10727	5267	2013	463	386	808
Age, yr
Mean (SD)	68.6 (10.4)	68.4 (10.5)	67.8 (10.8)	68.8 (10.3)	67.3 (10.2)	71.6 (10.4)	70.4 (9.3)	58.1 (11.5)	69.2 (8.2)	64.5 (10.7)
19-40	700 (0.9)	163 (0.8)	80 (1.2)	83 (0.6)	81 (0.8)	19 (0.4)	7 (0.3)	36 (7.8)	0 (0)	20 (2.5)
40-65	27937 (34.5)	6992 (35.6)	2452 (37.6)	4540 (34.5)	4274 (39.8)	1375 (26.1)	533 (26.5)	303 (65.4)	120 (31.1)	387 (47.9)
65-75	31156 (38.4)	7411 (37.7)	2396 (36.8)	5015 (38.1)	4078 (38.0)	1903 (36.1)	872 (43.3)	101 (21.8)	188 (48.7)	269 (33.3)
75-	21276 (26.2)	5098 (25.9)	1589 (24.4)	3509 (26.7)	2294 (21.4)	1970 (37.4)	601 (29.9)	23 (5.0)	78 (20.2)	132 (16.3)
Female sex	27371 (33.8)	6460 (32.9)	1928 (29.6)	4532 (34.5)	3717 (34.7)	1612 (30.6)	604 (30.0)	180 (38.9)	57 (14.8)	290 (35.9)
Charlson comorbidity Score
Mean (SD)	2.1 (1.1)	2.4 (1.2)	2.6 (1.2)	2.3 (1.2)	2.3 (1.2)	2.3 (1.2)	2.8 (1.2)	2.1 (1.1)	2.5 (1.2)	3.3 (1.0)
0	31441 (38.8)	5390 (27.4)	1597 (24.5)	3793 (28.9)	3255 (30.3)	1601 (30.4)	228 (11.3)	203 (43.8)	33 (8.5)	70 (8.7)
1	20410 (25.2)	4501 (22.9)	1304 (20.0)	3197 (24.3)	2571 (24.0)	1281 (24.3)	395 (19.6)	114 (24.6)	87 (22.5)	53 (6.6)
2	12609 (15.6)	3288 (16.7)	1099 (16.9)	2189 (16.7)	1785 (16.6)	900 (17.1)	331 (16.4)	64 (13.8)	93 (24.1)	115 (14.2)
3	7370 (9.1)	2378 (12.1)	779 (12.0)	1599 (12.2)	1240 (11.6)	596 (11.3)	317 (15.7)	36 (7.8)	71 (18.4)	118 (14.6)
≥ 4	9239 (11.4)	4107 (20.9)	1738 (26.7)	2369 (18.0)	1876 (17.5)	889 (16.9)	742 (36.9)	46 (9.9)	102 (26.4)	452 (55.9)
Comorbidity
Hypertension	38225 (47.2)	10902 (55.4)	3798 (58.3)	7104 (54.0)	5550 (51.7)	2832 (53.8)	1580 (78.5)	131 (28.3)	241 (62.4)	568 (70.3)
Diabetes mellitus	19632 (24.2)	6039 (30.7)	2169 (33.3)	3870 (29.4)	3109 (29.0)	1531 (29.1)	776 (38.5)	82 (17.7)	148 (38.3)	393 (48.6)
Coronary heart disease	9014 (11.1)	2737 (13.9)	1046 (16.1)	1691 (12.9)	1343 (12.5)	697 (13.2)	300 (14.9)	25 (5.4)	143 (37.0)	229 (28.3)
Stroke	4240 (5.2)	2377 (12.1)	1130 (17.3)	1247 (9.5)	789 (7.4)	466 (8.8)	998 (49.6)	24 (5.2)	28 (7.3)	72 (8.9)
COPD	19331 (23.8)	5691 (28.9)	1879 (28.8)	3812 (29.0)	3002 (28.0)	1585 (30.1)	522 (25.9)	89 (19.2)	267 (69.2)	226 (28.0)
Income
Medical aid	3816 (4.7)	2536 (12.9)	1329 (20.4)	1207 (9.2)	1155 (10.8)	636 (12.1)	287 (14.3)	254 (54.9)	59 (15.3)	145 (17.9)
1st quartile (lowest)	13784 (17.0)	3430 (17.4)	955 (14.7)	2475 (18.8)	2019 (18.8)	929 (17.6)	255 (12.7)	51 (11.0)	51 (13.2)	125 (15.5)
2nd quartile	13123 (16.2)	3067 (15.6)	946 (14.5)	2121 (16.1)	1759 (16.4)	807 (15.3)	272 (13.5)	46 (9.9)	63 (16.3)	120 (14.9)
3rd quartile	18562 (22.9)	4177 (21.2)	1288 (19.8)	2889 (22.0)	2352 (21.9)	1081 (20.5)	455 (22.6)	55 (11.9)	90 (23.3)	144 (17.8)
4th quartile (highest)	31784 (39.2)	6454 (32.8)	1999 (30.7)	4455 (33.9)	3442 (32.1)	1814 (34.4)	744 (37.0)	57 (12.3)	123 (31.9)	274 (33.9)
Place of residence
Metropolitan	46929 (57.9)	10620 (54.0)	3585 (55.0)	7035 (53.5)	5646 (52.6)	2825 (53.6)	1198 (59.5)	221 (47.7)	210 (54.4)	520 (64.4)
City	22329 (27.5)	6009 (30.6)	1983 (30.4)	4026 (30.6)	3341 (31.1)	1633 (31.0)	549 (27.3)	147 (31.7)	120 (31.1)	219 (27.1)
Rural	11811 (14.6)	3035 (15.4)	949 (14.6)	2086 (15.9)	1740 (16.2)	809 (15.4)	266 (13.2)	95 (20.5)	56 (14.5)	69 (8.5)
Type of cancer
Colon	44269 (54.6)	10985 (55.9)	3711 (56.9)	7274 (55.3)	5876 (54.8)	2949 (56.0)	1182 (58.7)	278 (60.0)	224 (58)	476 (58.9)
Rectosigmoid	6123 (7.6)	1591 (8.1)	530 (8.1)	1061 (8.1)	860 (8.0)	449 (8.5)	164 (8.1)	46 (9.9)	24 (6.2)	48 (5.9)
Rectum	30677 (37.8)	7088 (36.0)	2276 (34.9)	4812 (36.6)	3991 (37.2)	1869 (35.5)	667 (33.1)	139 (30.0)	138 (35.8)	284 (35.1)
Clinical disease status
Localized	29934 (36.9)	7322 (37.2)	2283 (35.0)	5039 (38.3)	4201 (39.2)	1829 (34.7)	664 (33.0)	123 (26.6)	150 (38.9)	355 (43.9)
Locoregional	34636 (42.7)	7985 (40.6)	2617 (40.2)	5368 (40.8)	4319 (40.3)	2243 (42.6)	832 (41.3)	193 (41.7)	142 (36.8)	256 (31.7)
Metastatic	9387 (11.6)	2484 (12.6)	889 (13.6)	1595 (12.1)	1279 (11.9)	681 (12.9)	298 (14.8)	88 (19.0)	50 (13.0)	88 (10.9)
Unknown	7112 (8.8)	1873 (9.5)	728 (11.2)	1145 (8.7)	928 (8.7)	514 (9.8)	219 (10.9)	59 (12.7)	44 (11.4)	109 (13.5)
Treatment within 6 months of diagnosis
Polypectomy, EMR, or ESD	11527 (14.2)	2849 (14.5)	877 (13.5)	1972 (15.0)	1683 (15.7)	677 (12.9)	223 (11.1)	43 (9.3)	63 (16.3)	160 (19.8)
Surgery only	31118 (38.4)	7611 (38.7)	2492 (38.2)	5119 (38.9)	4052 (37.8)	2132 (40.5)	801 (39.8)	162 (35.0)	147 (38.1)	317 (39.2)
Surgery + RT	2959 (3.6)	587 (3.0)	170 (2.6)	417 (3.2)	347 (3.2)	149 (2.8)	50 (2.5)	11 (2.4)	15 (3.9)	15 (1.9)
Surgery + Chemo	19409 (23.9)	4140 (21.1)	1233 (18.9)	2907 (22.1)	2467 (23.0)	1058 (20.1)	329 (16.3)	113 (24.4)	68 (17.6)	105 (13.0)
Surgery + CCRT	5339 (6.6)	1034 (5.3)	310 (4.8)	724 (5.5)	617 (5.8)	284 (5.4)	79 (3.9)	17 (3.7)	20 (5.2)	17 (2.1)
CCRT	691 (0.9)	171 (0.9)	68 (1.0)	103 (0.8)	82 (0.8)	50 (0.9)	15 (0.7)	4 (0.9)	11 (2.8)	9 (1.1)
Chemo only	2023 (2.5)	558 (2.8)	201 (3.1)	357 (2.7)	300 (2.8)	134 (2.5)	65 (3.2)	23 (5.0)	12 (3.1)	24 (3.0)
RT only	557 (0.7)	155 (0.8)	58 (0.9)	97 (0.7)	82 (0.8)	44 (0.8)	11 (0.5)	4 (0.9)	5 (1.3)	9 (1.1)
No treatment	7446 (9.2)	2559 (13.0)	1108 (17.0)	1451 (11.0)	1097 (10.2)	739 (14.0)	440 (21.9)	86 (18.6)	45 (11.7)	152 (18.8)
Screening subset, n	18760	3866	856	3010	2447	1072	216	27	53	51
Smoking
Current	5935 (31.6)	1161 (30.0)	267 (31.2)	894 (29.7)	754 (30.8)	319 (29.8)	58 (26.9)	9 (33.3)	7 (13.2)	14 (27.5)
Past	5146 (27.4)	1054 (27.3)	223 (26.1)	831 (27.6)	664 (27.1)	290 (27.1)	64 (29.6)	6 (22.2)	21 (39.6)	9 (17.6)
Non	7679 (40.9)	1651 (42.7)	366 (42.8)	1285 (42.7)	1029 (42.1)	463 (43.2)	94 (43.5)	12 (44.4)	25 (47.2)	28 (54.9)
Alcohol intake
Non-drinker	2082 (11.1)	596 (15.4)	151 (17.6)	445 (14.8)	353 (14.4)	149 (13.9)	47 (21.8)	11 (40.7)	19 (35.8)	17 (33.3)
Social amount	16096 (85.8)	3128 (80.9)	681 (79.6)	2447 (81.3)	2007 (82.0)	873 (81.4)	168 (77.8)	15 (55.6)	33 (62.3)	32 (62.7)
Heavy drinker	582 (3.1)	142 (3.7)	24 (2.8)	118 (3.9)	87 (3.6)	50 (4.7)	1 (0.5)	1 (3.7)	1 (1.9)	2 (3.9)
BMI, kg/m2
< 18.5	484 (2.6)	100 (2.6)	39 (4.6)	61 (2)	52 (2.1)	34 (3.2)	6 (2.8)	2 (7.4)	6 (11.3)	0 (0)
18.5-23.0	6105 (32.5)	1260 (32.6)	314 (36.7)	946 (31.4)	760 (31.1)	367 (34.2)	77 (35.6)	11 (40.7)	24 (45.3)	21 (41.2)
23.0-25.0	5227 (27.9)	1009 (26.1)	201 (23.5)	808 (26.8)	650 (26.6)	281 (26.2)	49 (22.7)	8 (29.6)	10 (18.9)	11 (21.6)
25.0-30.0	6438 (34.3)	1347 (34.8)	270 (31.5)	1077 (35.8)	878 (35.9)	358 (33.4)	77 (35.6)	6 (22.2)	12 (22.6)	16 (31.4)
≥ 30.0	506 (2.7)	150 (3.9)	32 (3.7)	118 (3.9)	107 (4.4)	32 (3.0)	7 (3.2)	0 (0)	1 (1.9)	3 (5.9)

SD: Standard deviation; COPD: Chronic obstructive pulmonary disease; RT: Radiotherapy.

Table 2 Distribution of cancer stage by disability, n (%)

	All	By cancer stage				P value
		Localized	Locoregional	Distant	Unknown
No. of patients	100733	37256 (37.0)	42621 (42.3)	11871 (11.8)	8985 (8.9)
People without disabilities	81069	29934 (36.9)	34636 (42.7)	9387 (11.6)	7112 (8.8)	< 0.0001
People with disability	19664	7322 (37.2)	7985 (40.6)	2484 (12.6)	1873 (9.5)
By disability grades
Severe (Grades 1-3)	6517	2283 (35.0)	2617 (40.2)	889 (13.6)	728 (11.2)	< 0.0001
Mild (Grades 4-6)	13147	5039 (38.3)	5368 (40.8)	1595 (12.1)	1145 (8.7)	< 0.0001
Grade 1	986	309 (31.3)	365 (37.0)	170 (17.2)	142 (14.4)
Grade 2	2402	872 (36.3)	953 (39.7)	299 (12.4)	278 (11.6)
Grade 3	3129	1102 (35.2)	1299 (41.5)	420 (13.4)	308 (9.8)
Grade 4	3531	1276 (36.1)	1447 (41.0)	470 (13.3)	338 (9.6)
Grade 5	4695	1812 (38.6)	1888 (40.2)	573 (12.2)	422 (9.0)
Grade 6	4921	1951 (39.6)	2033 (41.3)	552 (11.2)	385 (7.8)
By disability types
Physical
Grades 1-3	2306	853 (37.0)	937 (40.6)	293 (12.7)	223 (9.7)
Grades 4-6	8421	3348 (39.8)	3382 (40.2)	986 (11.7)	705 (8.4)
Communication
Grades 1-3	1423	464 (32.6)	596 (41.9)	192 (13.5)	171 (12.0)
Grades 4-6	3844	1365 (35.5)	1647 (42.8)	489 (12.7)	343 (8.9)
Brain
Grades 1-3	1400	438 (31.3)	572 (40.9)	219 (15.6)	171 (12.2)
Grades 4-6	613	226 (36.9)	260 (42.4)	79 (12.9)	48 (7.8)
Mental
Grades 1-3	463	123 (26.6)	193 (41.7)	88 (19.0)	59 (12.7)
Grades 4-6	-	-	-	-
Cardiopulmonary
Grades 1-3	385	149 (38.7)	142 (36.9)	50 (13.0)	44 (11.4)
Grades 4-6	1	1 (100.0)	0 (0.0)	0 (0.0)
Others
Grades 1-3	540	256 (47.4)	177 (32.8)	47 (8.7)	60 (11.1)
Grades 4-6	268	99 (36.9)	79 (29.5)	41 (15.3)	49 (18.3)

Table 3 Odds ratio for polypectomy, surgery, chemotherapy, radiotherapy, and no treatment

Overall mortality	Total No.	Polypectomy, EMR, ESD				Surgery+				CT+				RT+				No treatment
		No	Yes	Model 1	Model 2	No	Yes	Model 1	Model 2	No	Yes	Model 1	Model 2	No	Yes	Model 1	Model 2	No	Yes	Model 1	Model 2
Disability
Non-disabled patients	81069	69542	11527	REF	REF	22244	58825	REF	REF	53607	27462	REF	REF	71523	9546	REF	REF	73623	7446	REF	REF
Disabled patients	19664	16815	2849	1.022 (0.978-1.069)	0.998 (0.951-1.048)	6292	13372	0.804 (0.777-0.831)	0.848 (0.817-0.88)	13761	5903	0.837 (0.81-0.866)	0.837 (0.805-0.87)	17717	1947	0.823 (0.782-0.867)	0.895 (0.844-0.950)	17105	2559	1.479 (1.410-1.552)	1.389 (1.318-1.464)
By disability severity
Grades 1-3	6517	5640	877	0.938 (0.871-1.010)	0.909 (0.839-0.986)	2312	4205	0.688 (0.652-0.725)	0.743 (0.700-0.789)	4705	1812	0.752 (0.711-0.795)	0.703 (0.660-0.749)	5911	606	0.768 (0.705-0.837)	0.866 (0.784-0.956)	5409	1108	2.025 (1.891-2.170)	1.884 (1.744-2.034)
Grades 4-6	13147	11175	1972	1.065 (1.011-1.121)	1.041 (0.984-1.101)	3980	9167	0.871 (0.837-0.907)	0.904 (0.865-0.945)	9056	4091	0.882 (0.848-0.918)	0.908 (0.868-0.949)	11806	1341	0.851 (0.801-0.904)	0.909 (0.849-0.974)	11696	1451	1.227 (1.156-1.302)	1.166 (1.093-1.243)
Grade 1	986	879	107	0.735 (0.601-0.899)	0.741 (0.598-0.918)	415	571	0.520 (0.458-0.591)	0.592 (0.513-0.684)	756	230	0.594 (0.512-0.689)	0.508 (0.431-0.598)	910	76	0.626 (0.495-0.792)	0.772 (0.594-1.004)	731	255	3.452 (2.987-3.988)	2.913 (2.476-3.428)
Grade 2	2402	2061	341	0.998 (0.889-1.121)	0.941 (0.829-1.068)	877	1525	0.657 (0.604-0.715)	0.718 (0.653-0.789)	1786	616	0.673 (0.614-0.739)	0.655 (0.591-0.727)	2209	193	0.655 (0.564-0.760)	0.811 (0.686-0.959)	1982	420	2.095 (1.881-2.334)	1.917 (1.701-2.160)
Grade 3	3129	2700	429	0.959 (0.864-1.063)	0.937 (0.838-1.049)	1020	2109	0.782 (0.724-0.844)	0.821 (0.755-0.894)	2163	966	0.872 (0.807-0.942)	0.811 (0.743-0.884)	2792	337	0.904 (0.806-1.015)	0.927 (0.813-1.058)	2696	433	1.588 (1.431-1.762)	1.555 (1.388-1.742)
Grade 4	3531	3038	493	0.979 (0.888-1.079)	1.040 (0.936-1.155)	1097	2434	0.839 (0.780-0.902)	0.891 (0.823-0.966)	2478	1053	0.830 (0.771-0.893)	0.871 (0.802-0.946)	3193	338	0.793 (0.708-0.889)	0.893 (0.784-1.016)	3075	456	1.466 (1.325-1.622)	1.242 (1.113-1.385)
Grade 5	4695	4007	688	1.036 (0.953-1.126)	1.018 (0.931-1.114)	1460	3235	0.838 (0.786-0.893)	0.889 (0.829-0.953)	3298	1397	0.827 (0.775-0.882)	0.896 (0.833-0.963)	4240	455	0.804 (0.728-0.888)	0.882 (0.788-0.986)	4136	559	1.336 (1.220-1.464)	1.190 (1.078-1.314)
Grade 6	4921	4130	791	1.155 (1.068-1.250)	1.062 (0.975-1.157)	1423	3498	0.930 (0.872-0.991)	0.928 (0.866-0.994)	3280	1641	0.977 (0.919-1.038)	0.944 (0.881-1.011)	4373	548	0.939 (0.857-1.029)	0.944 (0.851-1.048)	4485	436	0.961 (0.869-1.064)	1.076 (0.966-1.198)
By disability type
Physical
Grades 1-3	2306	1968	338	1.036 (0.922-1.165)	0.966 (0.851-1.097)	763	1543	0.765 (0.700-0.835)	0.791 (0.717-0.871)	1573	733	0.910 (0.832-0.994)	0.806 (0.729-0.891)	2058	248	0.903 (0.790-1.032)	0.894 (0.768-1.041)	1997	309	1.530 (1.354-1.729)	1.636 (1.431-1.870)
Grades 4-6	8421	7076	1345	1.147 (1.078-1.220)	1.100 (1.028-1.176)	2481	5940	0.905 (0.862-0.951)	0.925 (0.877-0.977)	5688	2733	0.938 (0.894-0.984)	0.937 (0.887-0.989)	7541	880	0.874 (0.813-0.941)	0.895 (0.824-0.973)	7633	788	1.021 (0.945-1.103)	1.028 (0.946-1.116)
Communication
Grades 1-3	1423	1255	168	0.808 (0.687-0.950)	0.883 (0.743-1.050)	460	963	0.792 (0.708-0.886)	0.888 (0.784-1.005)	1012	411	0.793 (0.706-0.890)	0.855 (0.751-0.973)	1291	132	0.766 (0.640-0.917)	0.907 (0.74-1.112)	1193	230	1.906 (1.652-2.200)	1.429 (1.221-1.671)
Grades 4-6	3844	3335	509	0.921 (0.837-1.013)	0.967 (0.872-1.072)	1184	2660	0.850 (0.792-0.911)	0.899 (0.832-0.971)	2729	1115	0.798 (0.743-0.856)	0.883 (0.816-0.957)	3449	395	0.858 (0.772-0.954)	1.008 (0.893-1.138)	3335	509	1.509 (1.371-1.662)	1.266 (1.141-1.406)
Brain
Grades 1-3	1400	1260	140	0.670 (0.562-0.799)	0.684 (0.568-0.824)	560	840	0.567 (0.509-0.632)	0.606 (0.537-0.685)	1089	311	0.557 (0.491-0.633)	0.537 (0.467-0.617)	1295	105	0.607 (0.497-0.742)	0.758 (0.606-0.948)	1046	354	3.346 (2.959-3.784)	2.935 (2.557-3.370)
Grades 4-6	613	530	83	0.945 (0.749-1.192)	0.898 (0.699-1.153)	194	419	0.817 (0.688-0.969)	0.838 (0.695-1.012)	436	177	0.792 (0.665-0.944)	0.808 (0.664-0.982)	563	50	0.665 (0.498-0.889)	0.792 (0.573-1.093)	527	86	1.614 (1.283-2.029)	1.651 (1.287-2.119)
Mental
Grades 1-3	463	420	43	0.618 (0.451-0.846)	0.696 (0.498-0.973)	160	303	0.716 (0.591-0.868)	0.773 (0.622-0.960)	306	157	1.002 (0.826-1.215)	0.588 (0.475-0.728)	427	36	0.632 (0.449-0.888)	0.627 (0.428-0.919)	377	86	2.256 (1.782-2.854)	2.366 (1.827-3.064)
Grades 4-6
Cardiopulmonary
Grades 1-3	385	323	62	1.158 (0.882-1.521)	0.970 (0.724-1.301)	135	250	0.700 (0.568-0.864)	0.780 (0.620-0.981)	274	111	0.791 (0.634-0.986)	0.828 (0.648-1.059)	334	51	1.144 (0.851-1.537)	1.471 (1.039-2.081)	340	45	1.309 (0.958-1.788)	1.304 (0.934-1.822)
Grades 4-6	1	0	1	-	-	1	0	-	-	1	0	-	-	1	0	-	-	1	0	-	-
Other
Grades 1-3	540	414	126	1.836 (1.503-2.244)	1.387 (1.111-1.731)	234	306	0.494 (0.417-0.587)	0.573 (0.474-0.693)	451	89	0.385 (0.307-0.484)	0.406 (0.317-0.520)	506	34	0.503 (0.356-0.713)	0.691 (0.469-1.018)	456	84	1.821 (1.441-2.301)	1.858 (1.441-2.396)
Grades 4-6	268	234	34	0.877 (0.611-1.257)	0.659 (0.451-0.962)	120	148	0.466 (0.366-0.594)	0.579 (0.444-0.756)	202	66	0.638 (0.483-0.842)	0.579 (0.426-0.787)	252	16	0.476 (0.287-0.789)	0.412 (0.241-0.706)	200	68	3.362 (2.551-4.431)	3.286 (2.415-4.472)

Model 1 is unadjusted and model 2 is adjusted for age, sex, income level, place of residence, Charlson comorbidity index, and cancer stage. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; CT: Computed tomography; RT: Radiotherapy.

Table 4 Overall and colorectal cancer-specific mortality by disability

Overall mortality	Overall mortality				Cancer-specific mortality
	Total No.	No. of death	Incidence rate (per 1000 PY)	Adjusted HR (95%CI)	Total No.	No. of death	Incidence rate (per 1000 PY)	Adjusted HR (95%CI)
Disability
Non-disabled patients	81069	26908	51.3	REF	81069	19011	36.3	REF
Disabled patients	19664	7808	70.9	1.244 (1.213-1.277)	19664	5354	48.6	1.192 (1.156-1.229)
By disability severity
Grades 1-3	6517	3181	94.8	1.569 (1.512-1.630)	6517	2091	62.3	1.430 (1.366-1.498)
Grades 4-6	13147	4627	60.5	1.095 (1.061-1.130)	13147	3263	42.7	1.081 (1.042-1.123)
Grade 1	986	553	124.4	1.853 (1.702-2.017)	986	408	91.8	1.831 (1.659-2.022)
Grade 2	2402	1260	105.0	1.731 (1.634-1.833)	2402	775	64.6	1.502 (1.397-1.616)
Grade 3	3129	1368	79.9	1.372 (1.299-1.449)	3129	908	53.0	1.259 (1.177-1.346)
Grade 4	3531	1415	72.1	1.202 (1.139-1.269)	3531	1004	51.2	1.194 (1.120-1.272)
Grade 5	4695	1704	63.8	1.097 (1.044-1.152)	4695	1213	45.4	1.092 (1.030-1.157)
Grade 6	4921	1508	50.0	1.011 (0.960-1.065)	4921	1046	34.7	0.984 (0.924-1.047)
By disability type
Physical
Grades 1-3	2306	912	68.3	1.311 (1.227-1.401)	2306	649	48.6	1.290 (1.192-1.396)
Grades 4-6	8421	2675	53.0	1.044 (1.003-1.087)	8421	1914	37.9	1.042 (0.994-1.093)
Communication
Grades 1-3	1423	659	85.9	1.245 (1.152-1.346)	1423	446	58.1	1.170 (1.065-1.286)
Grades 4-6	3844	1562	73.0	1.136 (1.080-1.196)	3844	1091	51.0	1.115 (1.048-1.185)
Brain
Grades 1-3	1400	853	144.7	1.947 (1.817-2.086)	1400	601	101.9	1.897 (1.747-2.060)
Grades 4-6	613	275	88.4	1.490 (1.322-1.678)	613	178	57.3	1.369 (1.181-1.588)
Mental
Grades 1-3	463	219	102.1	2.230 (1.948-2.553)	463	173	80.6	2.074 (1.781-2.417)
Grades 4-6	-	-	-	-	-	-	-	-
Cardiopulmonary
Grades 1-3	385	212	110.1	1.754 (1.532-2.008)	385	107	55.6	1.257 (1.039-1.520)
Grades 4-6	1	1	740.9	19.971 (2.836-140.612)	1	1	740.9	40.45 (5.691-287.489)
Others
Grades 1-3	540	326	126.2	2.434 (2.179-2.719)	540	115	44.5	1.318 (1.096-1.586)
Grades 4-6	268	114	74.0	1.191 (0.990-1.432)	268	79	51.3	1.167 (0.935-1.456)

Adjusted for age, sex, Charlson comorbidity index, income level, place of residence, clinical disease status, type of surgery, and treatment, cancer stage, and type of cancer. 95%CI: 95% confidence interval; HR: Hazard ratio.

Table 5 Overall and colorectal cancer-specific mortality with local and locoregional who underwent surgery by disability

Overall mortality	Overall mortality				Cancer-specific mortality
	Total No.	No. of death	Incidence rate (per 1000 PY)	Adjusted HR (95%CI)	Total No.	No. of death	Incidence rate (per 1000 PY)	Adjusted HR (95%CI)
Disability
Non-disabled patients	59567	13842	32.7	REF	59567	8024	19.0	REF
Disabled patients	13532	3669	42.5	1.234 (1.189-1.280)	13532	2021	23.4	1.171 (1.114-1.23)
By disability severity
Grades 1-3	4045	1400	56.3	1.624 (1.535-1.717)	4045	733	29.5	1.453 (1.345-1.569)
Grades 4-6	9487	2269	36.9	1.086 (1.038-1.135)	9487	1288	20.9	1.059 (0.998-1.123)
Grade 1	539	191	59.0	1.677 (1.452-1.936)	539	116	35.8	1.698 (1.411-2.042)
Grade 2	1522	624	70.6	1.993 (1.837-2.162)	1522	295	33.4	1.638 (1.456-1.842)
Grade 3	1984	585	45.8	1.349 (1.242-1.467)	1984	322	25.2	1.260 (1.127-1.410)
Grade 4	2459	671	43.1	1.182 (1.094-1.278)	2459	392	25.2	1.181 (1.067-1.308)
Grade 5	3342	827	38.7	1.118 (1.042-1.200)	3342	476	22.3	1.104 (1.006-1.212)
Grade 6	3686	771	31.3	0.988 (0.918-1.062)	3686	420	17.1	0.927 (0.840-1.023)
By disability type
Physical
Grades 1-3	1601	429	40.8	1.310 (1.189-1.443)	1601	251	23.9	1.303 (1.148-1.479)
Grades 4-6	6204	1300	31.8	1.009 (0.953-1.069)	6204	756	18.5	0.995 (0.923-1.072)
Communication
Grades 1-3	940	299	49.1	1.270 (1.132-1.425)	940	166	27.3	1.211 (1.038-1.413)
Grades 4-6	2697	780	45.6	1.145 (1.065-1.231)	2697	434	25.4	1.113 (1.010-1.226)
Brain
Grades 1-3	844	376	81.1	2.014 (1.816-2.233)	844	210	45.3	1.938 (1.688-2.226)
Grades 4-6	438	144	56.7	1.555 (1.319-1.834)	438	75	29.5	1.420 (1.131-1.784)
Mental
Grades 1-3	281	86	53.5	2.016 (1.626-2.499)	281	56	34.8	1.811 (1.387-2.365)
Grades 4-6
Others
Grades 1-3	379	210	104.6	3.224 (2.807-3.704)	379	50	24.9	1.459 (1.102-1.931)
Grades 4-6	148	45	46.3	1.974 (1.473-2.647)	148	23	23.7	1.775 (1.178-2.674)

Adjusted for age, sex, Charlson comorbidity index, income level, place of residence, clinical disease status, type of surgery, and treatment, type of cancer. 95%CI: 95% confidence interval; HR: Hazard ratio.