Socioeconomic disparities in colorectal cancer survival: contributions of prognostic factors in a large Australian cohort

Xue Qin Yu; David Goldsbury; Eleonora Feletto; Cherry E Koh; Karen Canfell; Dianne L O'Connell

doi:10.1007/s00432-021-03856-4

Socioeconomic disparities in colorectal cancer survival: contributions of prognostic factors in a large Australian cohort

J Cancer Res Clin Oncol. 2022 Nov;148(11):2971-2984. doi: 10.1007/s00432-021-03856-4. Epub 2021 Nov 25.

Authors

Xue Qin Yu¹, David Goldsbury², Eleonora Feletto², Cherry E Koh^{3

4}, Karen Canfell^{2

5}, Dianne L O'Connell^{2

6}

Affiliations

¹ The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia. xueqiny@nswcc.org.au.
² The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, P O Box 572, Sydney, NSW, 1340, Australia.
³ Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁴ Discipline of Surgery, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
⁵ Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁶ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.

Abstract

Purpose: We quantified the contributions of prognostic factors to socioeconomic disparities in colorectal cancer survival in a large Australian cohort.

Methods: The sample comprised 45 and Up Study participants (recruited 2006-2009) who were subsequently diagnosed with colorectal cancer. Both individual (education attained) and neighbourhood socioeconomic measures were used. Questionnaire responses were linked with cancer registrations (to December 2013), records for hospital inpatient stays, emergency department presentations, death information (to December 2015), and Medicare and Pharmaceutical Benefits claims for subsidised procedures and medicines. Proportions of socioeconomic survival differences explained by prognostic factors were quantified using multiple Cox proportional hazards regression.

Results: 1720 eligible participants were diagnosed with colorectal cancer after recruitment: 1174 colon and 546 rectal cancers. Significant colon cancer survival differences were only observed for neighbourhood socioeconomic measure (p = 0.033): HR = 1.55; 95% CI 1.09-2.19 for lowest versus highest quartile, and disease-related factors explained 95% of this difference. For rectal cancer, patient- and disease-related factors were the main drivers of neighbourhood survival differences (28-36%), while these factors and treatment-related factors explained 24-41% of individual socioeconomic differences. However, differences remained significant for rectal cancer after adjusting for all these factors.

Conclusion: In this large contemporary Australian cohort, we identified several drivers of socioeconomic disparities in colorectal cancer survival. Understanding of the role these contributors play remains incomplete, but these findings suggest that improving access to optimal care may significantly reduce these survival disparities.

Keywords: Cancer epidemiology; Colorectal cancer; Socioeconomic status; Survival disparity.

MeSH terms

Aged
Australia / epidemiology
Cohort Studies
Colorectal Neoplasms* / mortality
Health Status Disparities*
Humans
Prognosis
Socioeconomic Factors
Survival Analysis