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Open Access Research article

Hospital factors and patient characteristics in the treatment of colorectal cancer: a population based study

Carlotta Sacerdote1*, Ileana Baldi1, Oscar Bertetto2, Daniela DiCuonzo1, Enzo Farina3, Eva Pagano1, Rosalba Rosato14, Carlo Senore5, Franco Merletti1 and Giovannino Ciccone1

Author Affiliations

1 Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Via Santena 7, 10129, Torino, Italy

2 Medical Oncology Unit, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy

3 General Surgery Unit, San Giovanni Battista Hospital, Corso Bramante 88, Turin, Italy

4 Department of Psychology, University of Turin, Turin, Italy

5 Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte, Via S Francesco da Paola 31, Turin, Italy

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BMC Public Health 2012, 12:775  doi:10.1186/1471-2458-12-775

Published: 12 September 2012

Abstract

Background

The present study focuses on the analysis of social, clinical and hospital characteristics that can lead to disparities in the management and outcome of care. To that end, indicators of the quality of initial treatment delivered to newly-diagnosed colorectal cancer patients in a North-Western Region of Italy, were investigated using administrative data.

Methods

The cohort includes all incident colorectal cancer patients (N = 24,187) selected by a validated algorithm from the Piedmont Hospital Discharge Record system over an 8-year period (2000–2007).

Three indicators of quality of care in this population-based cohort were evaluated: the proportion of preoperative radiotherapy (RT) and of abdominoperineal (AP) resection in rectal cancer patients, and the proportion of postoperative in-hospital mortality in colorectal cancer patients.

Results

Among rectal cancers, older patients were less likely to have preoperative RT, and more likely to receive an AP resection compared to younger patients. The probability of undergoing preoperative RT and AP resection was reduced in females compared to males (odds ratio (OR) 0.77, 95% confidence interval (CI) 0.64-0.93 and OR 0.78, 95%CI 0.69-0.89, respectively). However, there was a trend of increasing RT over time (p for trend <0.01). The probability of undergoing AP resection was increased in less-educated patients and in hospitals with a low caseload.

A higher risk of postoperative in-hospital mortality was found among colorectal cancer patients who were older, male, (female versus male OR 0.71, 95%CI 0.60-0.84), unmarried (OR 1.32, 95%CI 1.09-1.59) or with unknown marital status.

Conclusions

The study provides evidence of the importance of social, clinical and hospital characteristics on the equity and quality of care in a Southern European country with an open-access public health care system.

Keywords:
Colorectal cancer; Quality of care; Radiotherapy; In-hospital mortality; Hospital discharges