title: Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study.
abstract: BACKGROUND
  The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data.
  
  
  METHODS
  The cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000-2007).Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients.
  
  
  RESULTS
  Among rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload.A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status.
  
  
  CONCLUSIONS
  The study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.
authors.affiliation: Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Via Santena 7, 10129, Torino, Italy. carlotta.sacerdote@cpo.it
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Ileana
authors.initials: I
authors.lastname: Baldi
authors.forename: Oscar
authors.initials: O
authors.lastname: Bertetto
authors.forename: Daniela
authors.initials: D
authors.lastname: Dicuonzo
authors.forename: Enzo
authors.initials: E
authors.lastname: Farina
authors.forename: Eva
authors.initials: E
authors.lastname: Pagano
authors.forename: Rosalba
authors.initials: R
authors.lastname: Rosato
authors.forename: Carlo
authors.initials: C
authors.lastname: Senore
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Giovannino
authors.initials: G
authors.lastname: Ciccone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome