{"title":"澳大利亚维多利亚州结直肠癌患者急诊表现的地理和社会经济差异","authors":"Bedasa Taye Merga, Nikki McCaffrey, Suzanne Robinson, Craig Sinclair, Justin M. Yeung, Anita Lal","doi":"10.1002/cam4.70909","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Linked datasets from a Victorian population-based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a <i>p</i>-value threshold < 0.05.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty-one per cent (5086) of them reported CRC-related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = −0.060, <i>p</i>-value < 0.001) and regional and remote areas (CI = −0.065, <i>p</i>-value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced-stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45–49 age groups (65–69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.</p>\n </section>\n </div>","PeriodicalId":139,"journal":{"name":"Cancer Medicine","volume":"14 9","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70909","citationCount":"0","resultStr":"{\"title\":\"Geographic and Socioeconomic Disparities in Emergency Presentations Among Colorectal Cancer Patients in Victoria, Australia\",\"authors\":\"Bedasa Taye Merga, Nikki McCaffrey, Suzanne Robinson, Craig Sinclair, Justin M. Yeung, Anita Lal\",\"doi\":\"10.1002/cam4.70909\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Linked datasets from a Victorian population-based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a <i>p</i>-value threshold < 0.05.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty-one per cent (5086) of them reported CRC-related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = −0.060, <i>p</i>-value < 0.001) and regional and remote areas (CI = −0.065, <i>p</i>-value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced-stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45–49 age groups (65–69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.</p>\\n </section>\\n </div>\",\"PeriodicalId\":139,\"journal\":{\"name\":\"Cancer Medicine\",\"volume\":\"14 9\",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-05-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/cam4.70909\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancer Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70909\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cam4.70909","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
Geographic and Socioeconomic Disparities in Emergency Presentations Among Colorectal Cancer Patients in Victoria, Australia
Background
Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia.
Methods
Linked datasets from a Victorian population-based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a p-value threshold < 0.05.
Results
A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty-one per cent (5086) of them reported CRC-related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = −0.060, p-value < 0.001) and regional and remote areas (CI = −0.065, p-value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced-stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45–49 age groups (65–69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70).
Conclusions
Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.
期刊介绍：
Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas:
Clinical Cancer Research
Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations
Cancer Biology:
Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery.
Cancer Prevention:
Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach.
Bioinformatics:
Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers.
Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.
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