Disparities in short-term and long-term all-cause mortality among Korean cancer patients with and without preexisting disabilities: a nationwide retrospective cohort study

Park, Sang Min; Son, Ki Young; Park, Jae Hyun; Cho, Belong

doi:10.1007/s00520-011-1168-y

Cited by 5 publications

(5 citation statements)

References 31 publications

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“…The studies showed that cancer treatment was suboptimal for PwD in many ways, and in particular that they had a lower likelihood of undergoing guideline-consistent surgery when indicated [ 22 , 40 , 42 , 54 , 58 , 61 , 63 , 65 ]. Several studies showed that when PwD were correctly treated with guideline-consistent surgery, their mortality was similar or only slightly higher than controls [ 55 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

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Do people with disabilities experience disparities in cancer care? A systematic review

Tosetti,

Kuper

2023

PLoS ONE

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Background Over 1.3 billion people, or 16% of the world’s population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. Results Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. Discussion Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.

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Section: Resultsmentioning

confidence: 99%

“…Nine other studies (29%, n = 9) considered all disability in general or grouped into subcategories (e.g. physical/communication/mental/internal organ/others) [19,22,23,55,[58][59][60][61][62]. Few studies differentiated by severity of impairment [19,22,60,62,63].…”

Section: Types Of Disabilitiesmentioning

confidence: 99%

Do people with disabilities experience disparities in cancer care? A systematic review

Tosetti,

Kuper

2023

PLoS ONE

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“…A study of the Dutch adult population also found that cancer-related mortality was more common in individuals with intellectual disability [ 10 ]. Likewise, a previous study in Korea reported that cancer patients with disabilities had higher long-term all-cause mortality, and that such propensities also tended to persist in 5-year cancer survivors, suggesting the need for further collaborative efforts to improve the survival of cancer patients and survivors [ 23 ]. Another study similarly demonstrated a higher risk of overall mortality in cervical cancer patients with disabilities and concluded that social support and policies were needed to improve such disparities [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Disparities in All-Cause Mortality in Older Patients with Colorectal Cancer According to Disability Status: A Nationwide Analysis

et al. 2022

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Background: Although investigating patterns of cancer mortality is important in understanding the effect of cancer on population health, knowledge regarding mortality in cancer patients with disability is scarce. This study examined the association between disability status and all-cause mortality in older patients with colorectal cancer. Methods: Data were obtained from the 2008–2019 National Health Insurance Service claims data. The study population included patients with colorectal cancer aged 60 years or above. The outcome measure was all-cause 5-year and overall mortality. A survival analysis was performed using the Cox proportional hazards model to analyze the association between all-cause mortality and disability status. Subgroup analysis was conducted based on disability severity. Results: The study population consisted of 6340 patients, and disability was reported in 15.8% of the included individuals. Participants with disability had a higher risk of both all-cause 5-year (hazard ratio (HR) 1.21, 95% confidence interval (95% CI) 1.07–1.37) and overall mortality (HR 1.15, 95% CI 1.03–1.28). These findings were particularly significant in individuals with severe rather than mild disability. Conclusion: Older colorectal cancer patients with disabilities showed a higher risk of overall and 5-year all-cause mortality, which was evident in individuals with severe disabilities. The findings indicated disparities in mortality according to disability status. Further, we suggest that policies that can mediate such disparities must be strengthened.

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“…The Korean National Health Information Database used in this study provides a unique opportunity to analyze population features on a large scale. The Korean National Health Insurance Service covers all Korean citizens, and the random sample is designed to be nationally representative [61]. Its universal healthcare system with income-based premiums allows people to seek healthcare with less financial burden.…”

Section: Discussionmentioning

confidence: 99%

Association networks in a matched case-control design – Co-occurrence patterns of preexisting chronic medical conditions in patients with major depression versus their matched controls

Kim

Banerjee

Zhao

et al. 2018

Journal of Biomedical Informatics

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Objective We present a method for comparing association networks in a matched case-control design, which provides a high-level comparison of co-occurrence patterns of features after adjusting for confounding factors. We demonstrate this approach by examining the differential distribution of chronic medical conditions in patients with major depressive disorder (MDD) compared to the distribution of these conditions in their matched controls. Materials and Methods Newly diagnosed MDD patients were matched to controls based on their demographic characteristics, socioeconomic status, place of residence, and healthcare service utilization in the Korean National Health Insurance Service’s National Sample Cohort. Differences in the networks of chronic medical conditions in newly diagnosed MDD cases treated with antidepressants, and their matched controls, were prioritized with a permutation test accounting for the false discovery rate. Sensitivity analyses for the associations between prioritized pairs of chronic medical conditions and new MDD diagnosis were performed with regression modeling. Results By comparing the association networks of chronic medical conditions in newly diagnosed depression patients and their matched controls, five pairs of such conditions were prioritized among 105 possible pairs after controlling the false discovery rate at 5%. In sensitivity analyses using regression modeling, four out of the five prioritized pairs were statistically significant for the interaction terms. Conclusion Association networks in a matched case-control design can provide a high-level comparison of comorbid features after adjusting for confounding factors, thereby supplementing traditional clinical study approaches. We demonstrate the differential co-occurrence pattern of chronic medical conditions in patients with MDD and prioritize the chronic conditions that have statistically significant interactions in regression models for depression.

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Disparities in short-term and long-term all-cause mortality among Korean cancer patients with and without preexisting disabilities: a nationwide retrospective cohort study

Abstract: This study raises concerns with regard to disability-related disparities in cancer outcome among long-term cancer survivors. Further attention and effective collaborative efforts are required for improvement of survival and quality of care for long-term cancer survivors.

Cited by 5 publications

References 31 publications

Do people with disabilities experience disparities in cancer care? A systematic review

Do people with disabilities experience disparities in cancer care? A systematic review

Disparities in All-Cause Mortality in Older Patients with Colorectal Cancer According to Disability Status: A Nationwide Analysis

Association networks in a matched case-control design – Co-occurrence patterns of preexisting chronic medical conditions in patients with major depression versus their matched controls

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