title: Deprivation and access to treatment for colorectal cancer in Southeast Scotland 2003-2009.
abstract: OBJECTIVE
  Socioeconomic deprivation is associated with poorer survival from colorectal cancer. We examined the association of deprivation with access to treatment, disease stage at presentation and choice of treatment for colorectal cancer within a regional managed clinical network.
  
  
  METHODS
  We performed a retrospective analysis of data from the Southeast Scotland Cancer Network colorectal database for the period 2003-2009. Socioeconomic status was assigned into five categories using postcode of residence and the Scottish Index of Multiple Deprivation score. Outcomes were access to consultation and treatment, stage of disease at presentation and treatment factors (type of surgery, adjuvant radiotherapy and adjuvant chemotherapy).
  
  
  RESULTS
  Of 4960 colorectal cancer patients, 4016 patients (81%) underwent operative treatment. Deprivation was not associated with age, gender, tumour site, disease stage, delay in treatment pathway or permanent stoma rate. Primary tumour resection (P = 0.006) and chemotherapy treatment (P = 0.018) were higher in the least deprived compared with the most deprived quintile. Socioeconomic status was associated with both primary tumour resection [odds ratio for the most affluent compared with the most deprived quintiles (OR) 1.34, 95% confidence interval (CI) 1.05-1.72, P = 0.018] and chemotherapy treatment (OR 1.44, 95% CI 1.15-1.80, P = 0.001). However, when health board of treatment was added to the model, only chemotherapy treatment was independently associated with deprivation (OR 1.46, 95% CI 1.16-1.83, P = 0.001).
  
  
  CONCLUSIONS
  Deprivation is not associated with treatment delay or more advanced disease stage at presentation. An apparent association between deprivation and treatment choice may be explained by other differences between patients treated in different areas.
authors.affiliation: Colorectal Surgery Unit, Western General Hospital, Edinburgh, UK.
authors.forename: H M
authors.initials: HM
authors.lastname: Paterson
authors.forename: B J
authors.initials: BJ
authors.lastname: Mander
authors.forename: P
authors.initials: P
authors.lastname: Muir
authors.forename: H A
authors.initials: HA
authors.lastname: Phillips
authors.forename: S H
authors.initials: SH
authors.lastname: Wild
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D012959:Socioeconomic Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: Colorectal cancer; colorectal surgery; socioeconomic status