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Published on: September 27, 2024
Socioeconomic Disadvantage, but Not Remote Location, Is Associated With Poorer Survival After Resection of Colon
Michael Leon Russell Lonne1, Amy Millicent Yesheng Cao1,2, Ashley Jenkin1
1Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Background:
Previous studies have demonstrated a social gradient in survival outcomes for colorectal cancer. The aim of this study was to determine the effect of socioeconomic status and geographic remoteness on overall (OS) and cancer-specific survival (CSS) for patients with non-metastatic colon cancer in Queensland.
Methods:
A population-based retrospective cohort study between 1 January 2001 and 30 December 2021 utilising data from the Queensland Oncology Repository.
Results:
A total of 29 749 patients met the inclusion criteria, with a median follow up time of 71 months. Both OS and CSS for those that were socioeconomically disadvantaged were significantly lower than those who were middle SES and affluent at all-time points (p < 0.001). In multivariate Cox proportional hazards analysis, after accounting for age, stage, sex, ASA and geographic remoteness, the hazard ratio (HR) for overall and cancer-specific death in those that were disadvantaged compared to those that were affluent and middle SES was 1.13 (95% 1.01-1.25, p = 0.03) and 1.18 (95% CI 1.01-1.39, p = 0.04), respectively. Patients who were socioeconomically disadvantaged were less likely to be from a major city than those who were middle SES and affluent (32.8% vs. 70.2% and 97.1%, respectively, p < 0.001). Geographic remoteness itself had no effect on OS or CSS in multivariate analysis.
Conclusion:
Despite significant advances in healthcare, socioeconomic disadvantage remains a predictor of poor prognosis for patients with non-metastatic colon cancer in Queensland. Further efforts are needed to ensure equitable provision of services to improve outcomes in this vulnerable population.
