Background/Objectives: Research on the relationship between small-area-level deprivation and cancer survival, particularly for colorectal cancer (CRC), is lacking. Therefore, we investigated the relationship among small area-level deprivation, individual-level factors, and CRC survival using data from the Busan Regional Cancer Registry. Methods: We analyzed 34,999 patients with CRC from the Busan Regional Cancer Registry from 2003 to 2020. The primary outcome was CRC mortality. The explanatory variables at the individual level included age, gender, cancer stage, and year of diagnosis, whereas the Deprivation Index (DI) was used at the regional level. We conducted a multilevel survival analysis with frailty to assess the impact of individual- and area-level factors on survival probabilities. Results: In the multilevel survival model, each unit increase in the DI at the area level was associated with a 6.6% decrease in survival probability. When applying Model 2 and deriving regional estimates using the empirical Bayesian estimation method, the graph of the DI (x-axis) against survival probability (y-axis) showed that the slope of the regional DI for the 3-year and 5-year survival probabilities increased compared with the 1-year rate across all stages of the disease. Additionally, the slopes were steeper for the distant stage than for the local or regional stages. Conclusions: Small-area level deprivation negatively affects CRC survival, especially in distant-stage patients and those with longer disease duration.
背景/目的：目前关于小区域层面贫困与癌症生存率关系的研究，特别是针对结直肠癌（CRC）的研究尚不充分。因此，我们利用釜山地区癌症登记处的数据，探讨了小区域层面的贫困、个体层面因素与结直肠癌生存率之间的关系。方法：我们分析了2003年至2020年间釜山地区癌症登记处的34,999例结直肠癌患者。主要研究结果为结直肠癌死亡率。个体层面的解释变量包括年龄、性别、癌症分期和诊断年份，而区域层面则采用贫困指数（DI）。我们采用带脆弱性的多水平生存分析方法，评估个体层面和区域层面因素对生存概率的影响。结果：在多水平生存模型中，区域层面贫困指数每增加一个单位，生存概率下降6.6%。当应用模型2并采用经验贝叶斯估计方法推导区域估计值时，贫困指数（x轴）与生存概率（y轴）的关系图显示，与1年生存率相比，所有疾病分期的3年和5年生存概率的区域贫困指数斜率均有所增加。此外，远处转移分期的斜率比局部或区域分期的斜率更陡。结论：小区域层面的贫困对结直肠癌生存率产生负面影响，尤其是对于远处转移期患者和病程较长的患者。
肿瘤(癌症)患者之家