身心障礙者罹患大腸直腸癌延遲治療情形及死亡風險

目標：大腸直腸癌為我國最常見癌症。本研究探討身心障礙者罹患大腸直腸癌延遲治療情形及死亡風險。方法：為回溯性世代研究，利用癌症登記檔資料擷取2008~2015年新登記為大腸直腸癌者，串聯內政部身心障礙者資料及衛福部健保資料庫，篩選出研究對象計11,967人，追蹤至2016年年底，觀察其延遲治療情形及死亡風險。除了描述性統計及雙變項分析外，利用羅吉斯迴歸分析探討是否延遲治療之相關因素，以Cox model探討是否延遲之相對死亡風險。結果：共計有2,840人延遲治療（佔23.73%），年齡越大、共病嚴重度越高、有其他重大傷病者，延遲治療比率越高（p<0.05）。罹癌以第2期延遲治療比率最高（佔36.53%），其延遲治療風險較第1期高1.31倍。有延遲治療者每千人年死亡率較高（21.19‰vs. 19.50‰），死亡風險亦較高（HR: 1.09）。結論：在全民健保制度下，身心障者罹患大腸直腸癌延遲治療比率高達23.73%，顯示該族群民眾受限於障礙，會影響其接受治療可近性。本研究結果可供相關單位在癌症防治及身心障礙者健康照護政策擬定之參考。

Objectives: Colorectal cancer (CRC) is the most prevalent cancer in Taiwan. In this study, we evaluated the incidence rates of treatment delay and mortality among individuals with disability and CRC. Methods: This retrospective cohort study was conducted using data from patients with CRC who were registered in the Taiwan Cancer Registry between 2008 and 2015. The obtained data were cross-referenced with the disability registry data from Taiwan’s Ministry of the Interior and National Health Insurance Research Database. The included patients were followed up until the end of 2016. Descriptive statistics were used and bivariate, logistic regression, and Cox proportional-hazards analyses were performed to identify factors and risks associated with treatment delay and mortality. Results: This study included 11,967 patients; of them, 2,840 patients (23.73%) experienced treatment delay. Older age, elevated Charlson Comorbidity Index scores, and the presence of other catastrophic illnesses were associated with treatment delay (all p < .05). The incidence rate of treatment delay was the highest in individuals with stage 2 CRC (36.53%), with the risk being 1.31 times higher than that in patients with stage 1 CRC. Compared with patients who did not experience treatment delay, those who experienced treatment delay had an elevated mortality rate (19.50‰vs. 21.19‰, respectively) and an increased (by 1.09 times) mortality risk. Conclusions: According to the universal health insurance system, the incidence rate of treatment delay is high (23.73%) among individuals with disability and CRC. This suggests that disability and other pertinent factors impede the access to timely treatment in this patient population. Our findings may guide health-care policies for individuals with disability and facilitate effective initiatives toward cancer prevention.