Disability-related disparities in diagnosis and survival of cancer of the digestive system: a population-based study in Northern Italy
1
PhD National Programme in One Health approaches to infectious diseases and life science research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
2
School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
3
Epidemiology Unit, Agency for Health Protection of Milan, Milan, Italy
4
Research Department of Behavioural Science and Health, University College London, London, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A2990
ABSTRACT
BACKGROUND:
Individuals with disabilities may experience disparities in cancer diagnosis, but population-based evidence is limited. This study aims to investigate variations in diagnostic routes and survival for patients diagnosed with digestive system cancer by different types of preexisting functional impairments.
METHODS:
Using linked cancer registration and electronic health record data, we conducted a population-based cohort study on digestive system cancers diagnosed between 2018 and 2021 in Milan. We assessed cancer diagnostic routes (emergency presentation [EP] versus screening/inpatient/outpatient visits) and survival in patients with and without pre-existing impairments, adjusting for cancer site, metastatic status, comorbidities, socio-demographic factors and period. Impairments were classified according to the International Classification of Functioning, Disability and Health. Using multivariable logistic regression, we examined the risk of EP for people with versus without different impairment categories. We also estimated adjusted 1-year survival using Cox proportional hazard models.
RESULTS:
Among 16,964 cancer patients, 6.5% had pre-existing impairments of mental functions, 2.8% of sensory functions, 3.1% of neuromusculoskeletal/movement-related functions, 5.8% of continence functions, and 10.2% prosthetic/orthotic impairments. Compared with patients without impairments, the risk of EP was higher among those with impairments of mental functions (51.8% vs. 37.9%; adjusted OR [aOR]=1.41, 95% CI 1.23–1.61), neuromusculoskeletal/movement (50.4% vs. 38.4%; aOR=1.30, 95%CI 1.08–1.57), and prosthetic/orthotic impairments (49.0% vs 37.6%; aOR=1.24, 95%CI 1.09–1.40). One-year hazard of death was higher among patients with impairments, independently of socio-demographic and clinical characteristics, particularly among those with impairments of mental functions (HR=1.36, 95%CI 1.26–1.46). One-year survival was poorer after EP for patients with impairment of mental functions or continence functions.
CONCLUSIONS:
Individuals with different impairments have a higher risk of emergency cancer diagnosis and lower survival, independently of comorbidities and other patient characteristics. Tailored strategies are warranted to support equitable access to timely cancer diagnosis for the non-negligible group of individuals with disabilities.
Individuals with disabilities may experience disparities in cancer diagnosis, but population-based evidence is limited. This study aims to investigate variations in diagnostic routes and survival for patients diagnosed with digestive system cancer by different types of preexisting functional impairments.
METHODS:
Using linked cancer registration and electronic health record data, we conducted a population-based cohort study on digestive system cancers diagnosed between 2018 and 2021 in Milan. We assessed cancer diagnostic routes (emergency presentation [EP] versus screening/inpatient/outpatient visits) and survival in patients with and without pre-existing impairments, adjusting for cancer site, metastatic status, comorbidities, socio-demographic factors and period. Impairments were classified according to the International Classification of Functioning, Disability and Health. Using multivariable logistic regression, we examined the risk of EP for people with versus without different impairment categories. We also estimated adjusted 1-year survival using Cox proportional hazard models.
RESULTS:
Among 16,964 cancer patients, 6.5% had pre-existing impairments of mental functions, 2.8% of sensory functions, 3.1% of neuromusculoskeletal/movement-related functions, 5.8% of continence functions, and 10.2% prosthetic/orthotic impairments. Compared with patients without impairments, the risk of EP was higher among those with impairments of mental functions (51.8% vs. 37.9%; adjusted OR [aOR]=1.41, 95% CI 1.23–1.61), neuromusculoskeletal/movement (50.4% vs. 38.4%; aOR=1.30, 95%CI 1.08–1.57), and prosthetic/orthotic impairments (49.0% vs 37.6%; aOR=1.24, 95%CI 1.09–1.40). One-year hazard of death was higher among patients with impairments, independently of socio-demographic and clinical characteristics, particularly among those with impairments of mental functions (HR=1.36, 95%CI 1.26–1.46). One-year survival was poorer after EP for patients with impairment of mental functions or continence functions.
CONCLUSIONS:
Individuals with different impairments have a higher risk of emergency cancer diagnosis and lower survival, independently of comorbidities and other patient characteristics. Tailored strategies are warranted to support equitable access to timely cancer diagnosis for the non-negligible group of individuals with disabilities.
| eISSN: | 2654-1459 |
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