Geographic and Socioeconomic Disparities in Emergency Presentations Among Colorectal Cancer Patients in Victoria, Australia

TL;DR

This study finds that colorectal cancer patients in disadvantaged and remote areas in Victoria are more likely to present as emergencies, leading to worse outcomes.

Contribution

The study identifies geographic and socioeconomic disparities in emergency presentations for colorectal cancer in Victoria using population-based data.

Findings

Emergency presentations were higher among socioeconomically disadvantaged groups and in regional/remote areas.

Advanced-stage diagnoses and older age groups were associated with lower odds of emergency presentation.

Improving primary care access and screening in disadvantaged areas could reduce disparities and improve outcomes.

Abstract

Disparities in cancer care access and utilisation influence the stage of diagnosis and pathways of care. Colorectal cancer (CRC) patients presenting as emergencies often have advanced disease and poorer outcomes. This study aimed to assess geographic and socioeconomic disparities in emergency presentations (EPs) of CRC patients in Victoria, Australia.

Linked datasets from a Victorian population‐based cancer registry and emergency and hospital admissions were analysed for CRC patients diagnosed between 2009 and 2022. Concentration indices (CIs) assessed the distribution of EPs by socioeconomic position and remoteness. Multivariable logistic regression identified factors associated with EPs, with results presented as adjusted odds ratios and 95% confidence intervals. In all analyses, statistical significance was determined using a p‐value threshold < 0.05.

A total of 24,236 CRC patients had emergency department (ED) visits for any reason. Twenty‐one per cent (5086) of them reported CRC‐related symptoms. Among these, 33.8% (1721) presented within 6 months before diagnosis. The concentration indices indicated that EPs were disproportionately higher among the most disadvantaged quintiles (CI = −0.060, p‐value < 0.001) and regional and remote areas (CI = −0.065, p‐value < 0.001). Multivariable logistic regression showed higher odds of EPs among socioeconomically disadvantaged groups (Q1: AOR = 1.25; Q2: AOR = 1.31) compared to the least disadvantaged (Q5). Similarly, patients in regional and remote areas had higher odds of EP than those in major cities (inner regional: AOR = 1.26; outer regional/remote: AOR = 1.52). Advanced‐stage diagnoses compared to early stages (stage 4: AOR = 1.67), whereas older age groups had lower odds compared to 45–49 age groups (65–69 years: AOR = 0.67, > = 75 years, AOR = 0.60 to 0.70).

Enhancing access to primary care and strengthening cancer screening programs, particularly in socioeconomically disadvantaged and regional, and remote communities, could reduce disparities, promote earlier diagnosis, and improve outcomes. Prioritising targeted interventions in these populations is essential to addressing these inequities.

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