Introduction In recent years there has been increasing recognition of the impact of socioeconomic status (SES) on the stage at diagnosis for many different cancers. Studies demonstrate lower SES is associated with a more advanced stage of cancer at diagnosis. There is very little published evidence observing the impact of rurality on cancer diagnosis. North Wales has both a wide range in socioeconomic status with large rural areas. We aim to examine the impact of both SES and rurality on the diagnosis of colorectal cancer in North Wales.
Method This was a retrospective observational study. Data from the North Wales cancer registry was used to identify all patients with a diagnosis of colorectal cancer from January 2009–July 2014.
Patient case details were then cross referenced with local coding data, clinical/histopathological records and imaging records.
Patients geographical data was used to group them into super output areas based on the 2011 Census. Patient data was then correlated with markers of SES and the Welsh index of multiple deprivation 2014 (WIMD) using SPSS software.
Results N=942 spread over 154 super output areas. There was no difference in colorectal cancer incidence between the super output areas (p = 0.375)
797 patients had their disease scored in terms of severity based on combined histological and radiological findings. Comparison of this score with markers of SES, showed that in areas with higher SES i.e. higher proportion of people with professional occupations disease severity was significantly less (p = 0.027). In areas where there was a higher proportion of elementary occupations i.e. lower SES there was significantly more severe disease at presentation (p = 0.035). In addition increased deprivation in terms of education in an area was associated with more severe disease at presentation (p = 0.048).
Severity at presentation and circumstances of presentation (emergency vs elective) was not affected by reduced access to services i.e. increased rurality (p = 0.095).
Conclusion Our data confirm the findings of previous studies that patients from areas of lower SES present with a more advanced stage of colorectal cancer at diagnosis. Improved health education is required to address this disparity. Interestingly rurality did not appear to impact on cancer presentation.
Disclosure of interest None Declared.
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