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Effect of Social Deprivation on the Stage and Mode of Presentation of Colorectal Cancer

대한대장항문학회지 2016년 32권 4호 p.128 ~ 132
 ( Ahmed ELHadi ) - UK James Paget University Hospital Department of General Surgery

 ( Sarah Ashford-Wilson ) - UK James Paget University Hospital Department of General Surgery
 ( Stephanie Brown ) - UK James Paget University Hospital Department of General Surgery
 ( Atanu Pal ) - UK James Paget University Hospital Department of General Surgery
 ( Roshan Lal ) - UK James Paget University Hospital Department of General Surgery
 ( Kamal Aryal ) - UK James Paget University Hospital Department of General Surgery

Abstract


Purpose: Based in a hospital serving one of the most deprived areas in the United Kingdom (UK), we aimed to investigate, using the Indices of Deprivation 2010, the hypothesis that deprivation affects the stage and mode of presentation of colorectal cancer.

Methods: All newly diagnosed patients with colorectal cancer presenting to a District General Hospital in the UK between January 2010 and December 2014 were included. Data were collected from the Somerset National Cancer Database. The effect of social deprivation, measured using the Index of Multiple Deprivation Score, on the stage and mode of presentation was evaluated utilizing Microsoft Excel and IBM SPSS ver. 22.0.

Results: A total of 701 patients (54.5% male; mean age, 76 years) were included; 534 (76.2%) underwent a surgical procedure, and 497 (70.9%) underwent a colorectal resection. Of the patients undergoing a colorectal resection, 86 (17.3%) had an emergency surgical resection. Social deprivation was associated with Duke staging (P = 0.09). The 90-day mortality in patients undergoing emergency surgery was 12.8% compared to 6.8% in patients undergoing elective surgery (P = 0.06). No association was found between deprivation and emergency presentation (P = 0.97). A logistic regression analysis showed no increase in the probability of metastasis amongst deprived patients.

Conclusion: This study suggests an association between deprivation and the stage of presentation of colorectal cancer. Patients undergoing emergency surgery tend to have a higher 90-day mortality rate, although this was not related to deprivation. This study highlights the need to develop an individual measure to assess social deprivation.

키워드

Colorectal neoplasms; Socioeconomic status
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