The impact of socioeconomic status on overall survival in patients with colorectal cancer: a systematic review and meta-analysis

W.Y. Chua , A. Yong , O. Lim , I. Seow-En , D. Chong , E. Wong , S. Han , S.-L. Koo , I. Tan , K.Y.Y. Ng
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Abstract

Introduction

Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer-related mortality worldwide. Patients are typically diagnosed at an early stage due to widespread use of colonoscopy screenings and stool testing. Despite the efficacy of early detection in CRC, there are concerns about the accessibility of these treatments for patients of lower socioeconomic status (SES), which may lead to poorer outcomes and exacerbate health inequity.

Patients and methods

We searched Medline and Embase from inception to 26 April 2024 to identify cohort studies comparing SES indicators and CRC outcomes. We computed hazard ratios (HRs) with accompanying 95% confidence intervals (CIs) for each study, and pooled the results using a random-effects meta-analysis. Quality assessment was carried out using Newcastle–Ottawa Quality Assessment Scale for cohort studies.

Results

In this meta-analysis of 37 studies involving 2 017 509 patients, we analysed the impact of SES on overall survival in patients with CRC. All but three studies were conducted in high-income countries. Our main findings demonstrated that lower income (HR 1.16, 95% CI 1.08-1.23, P < 0.0001), lower educational level (HR 1.24, 95% CI 1.17-1.31, P < 0.0001), lower neighbourhood SES (HR 1.22, 95% CI 1.19-1.25, P < 0.0001), and lower insurance coverage (HR 1.29, 95% CI 1.25-1.32, P < 0.0001) had a negative impact on overall survival in patients with CRC.

Conclusion

Lower income, educational level, insurance coverage, and neighbourhood SES had a negative impact on overall survival in patients with CRC. There is an urgent need to develop and implement interventions to reduce disparities in outcomes for patients with CRC who are of lower SES.
社会经济地位对结直肠癌患者总体生存的影响:一项系统回顾和荟萃分析
结直肠癌(CRC)是世界上第三大最常见的恶性肿瘤,也是导致癌症相关死亡的第三大原因。由于结肠镜检查和粪便检查的广泛使用,患者通常在早期被诊断出来。尽管早期发现结直肠癌有效,但人们担心这些治疗对社会经济地位较低的患者的可及性,这可能导致较差的结果并加剧健康不平等。患者和方法我们检索了Medline和Embase从成立到2024年4月26日,以确定比较SES指标和CRC结果的队列研究。我们计算了每项研究的风险比(hr)和随附的95%置信区间(ci),并使用随机效应荟萃分析汇总了结果。采用纽卡斯尔-渥太华质量评估量表对队列研究进行质量评估。在这项涉及2017509例患者的37项研究的荟萃分析中,我们分析了SES对结直肠癌患者总生存的影响。除了三项研究外,其他研究都是在高收入国家进行的。我们的主要研究结果表明,较低的收入(HR 1.16, 95% CI 1.08-1.23, P < 0.0001)、较低的教育水平(HR 1.24, 95% CI 1.17-1.31, P < 0.0001)、较低的社区经济地位(HR 1.22, 95% CI 1.19-1.25, P < 0.0001)和较低的保险覆盖率(HR 1.29, 95% CI 1.25-1.32, P < 0.0001)对结直肠癌患者的总体生存有负面影响。结论较低的收入、教育程度、保险覆盖率和社区社会经济地位对结直肠癌患者的总体生存有负面影响。迫切需要制定和实施干预措施,以减少社会经济地位较低的结直肠癌患者预后的差异。
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