title: Factors associated with late stage at diagnosis among Puerto Rico's government health plan colorectal cancer patients: a cross-sectional study.
abstract: Late stage at diagnosis of cancer is considered a key predictor factor for a lower survival rate. Knowing and understanding the barriers to an early diagnosis of colorectal cancer is critical in the fight to reduce the social and economic burden caused by cancer in Puerto Rico. This study evaluates factors associated to colorectal cancer stage at diagnosis among Puerto Rico's Government Health Plan (GHP) patients.
  
  
  
  We conducted a cross-sectional study based on a secondary data analysis using information from the Puerto Rico Central Cancer Registry (PRCCR) and the Puerto Rico Health Insurance Administration (PRHIA). Logistic regression models were used to estimate the unadjusted odds ratio (ORs) and adjusted odds ratio (AORs), and their 95 % confidence intervals (CIs). Colorectal cancer cases diagnosed between January 1, 2012 and December 31, 2012, among persons 50 to 64 years of age, participants of the GHP and with a cancer diagnosis reported to the PRCCR were included in the study.
  
  
  
  There were 68 (35.79 %) colorectal cancer patients diagnosed at early stage while 122 (64.21 %) where diagnosed at late stage. In the multivariate analysis having a diagnostic delay of more than 59 days (AOR 2.94, 95 % CI: 1.32 to 6.52) and having the first visit through the emergency room (AOR 3.48, 95 % CI: 1.60 to 7.60) were strong predictors of being diagnosed with colorectal cancer at a late stage.
  
  
  
  These results are relevant to understand the factors that influence the outcomes of colorectal cancer patients in the GHP. Therefore, it is important to continue developing studies to understand the Government Health Plan patient's pathways to a cancer diagnosis, in order to promote assertive decisions to improve patient outcomes.
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico. karen.ortiz@upr.edu.|Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico. karen.ortiz@upr.edu.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Ortiz-Ortiz
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Ruth
authors.initials: R
authors.lastname: Ríos-Motta
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Heriberto
authors.initials: H
authors.lastname: Marín-Centeno
authors.affiliation: Department of Surgery, Biochemistry and Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Marcia
authors.initials: M
authors.lastname: Cruz-Correa
authors.affiliation: Cancer Control and Population Sciences Program, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.|Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Ana Patricia
authors.initials: AP
authors.lastname: Ortiz
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006078:Government Programs; D006285:Health Planning; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011647:Puerto Rico; D012042:Registries
keywords: Colorectal cancer; Delayed diagnosis; Health services accessibility; Primary health care; Stage at diagnosis