title: Socio-economic disadvantage and demographics as factors in stage of colorectal cancer presentation and survival.
abstract: BACKGROUND
  Colorectal cancer (CRC) is common, and early diagnosis improves outcome. Overseas studies have suggested that low socio-economic status (SES) is related to advanced cancer stage at presentation and reduced survival. The situation in Australia is unclear. This study examines the effect of demographic and SES on CRC stage at presentation and survival in a single tertiary centre.
  
  
  METHODS
  Patients undergoing surgical resection for CRC (1 January 2005 to 31 December 2010) were identified, and socio-demographic and histopathological information obtained. Four socio-economic indices using 2006 Australian Census data were assigned by residential postcode. Factors contributing to tumour (T) and American Joint Committee on Cancer (AJCC) stage at presentation and survival were assessed.
  
  
  RESULTS
  Five hundred and fifty-seven patients were included. Results did not support a relationship between SES and either advanced stage at presentation or survival. Only one index (economic resources) was related to a more advanced T stage at presentation (P = 0.011); none were related to AJCC stage or survival. No significant relationship was found between an individual's country of birth, language spoken, private insurance or employment status and presenting with a later T or AJCC stage. Age, AJCC and T stage at diagnosis and emergency presentation significantly affected survival on multivariate analysis.
  
  
  CONCLUSIONS
  SES and most demographic factors did not appear to significantly influence CRC stage at presentation and outcome. A focus on obtaining equivalent access to health care both nationally and internationally could prove beneficial in improving outcomes for CRC.
authors.affiliation: Department of Surgery, The Northern Hospital, Melbourne, Victoria, Australia; Department of Surgery, School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Barclay
authors.forename: Paul-Jon
authors.initials: PJ
authors.lastname: Goh
authors.forename: Terri J
authors.initials: TJ
authors.lastname: Jackson
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D003710:Demography; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012923:Social Class; D014739:Victoria
keywords: Australia; colorectal cancer; socio-economic status; staging