Determinants of Healthcare Utilisation and Predictors of Outcome in Colorectal Cancer Patients From Northern Iran

Eur J Cancer Care (Engl). 2016 Mar;25(2):318-23. doi: 10.1111/ecc.12313. Epub 2015 Mar 20.

Abstract

We aimed to assess healthcare utilisation (HU), its determinants, as well as its relationship with survival in colorectal cancer (CRC) patients. This study was conducted on incident CRC cases from Northern Iran. Information on HU was collected using a valid questionnaire, considering eight diagnostic and four therapeutic services. The results were categorised as good and poor HU. Multivariate logistic regression analysis was used to assess the relationship between HU and other variables. Cox regression analysis was performed to determine major predictors of survival. In total, 227 new cases of CRC were enrolled. HU could be assessed in 218 subjects (96%). Living in rural areas was the strongest variable related to poor HU (adjusted OR, odds ratio = 2.65; CI, confidence interval: 1.30-5.40). The median survival time was 40.5 months. The 1-, 3- and 5-year survival rates were 71%, 52% and 44% respectively. Cox regression analysis showed a significant lower survival rate in patients with poor HU (HR = 2.3; CI: 1.46-3.64). HU was an independent predictor of survival in our CRC patients. Patients' place of residence was a significant determinant of HU. Regarding its effects on patients' outcome, HU and its determinants should be considered in designing CRC controlling programmes in our region and similar high-risk populations.

Keywords: colorectal cancer; healthcare utilisation, Iran; survival.

MeSH terms

  • Adult
  • Aged
  • Colorectal Neoplasms / mortality*
  • Cross-Sectional Studies
  • Female
  • Health Services / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Iran
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Proportional Hazards Models
  • Residence Characteristics / statistics & numerical data
  • Rural Population
  • Surveys and Questionnaires
  • Survival Rate
  • Urban Population