Abstract
Colorectal cancer (CRC) is a health problem with a significant social impact, accounting for 700,000 deaths a year globally. CRC survival rates are increasing as a result of early detection and improvements in society and labor conditions. Differences in CRC have been found depending on place of residence (urban or rural), socioeconomic situation and unemployment, although studies in this regard are limited. The aims of the present study were to determine whether differences exist in diagnostic delay according to place of residence, to analyze the association between socioeconomic level and colonoscopy results and to evaluate CRC risk according to place of residence, income level and unemployment. Retrospective, descriptive and observational study based on colonoscopies performed between May 2015 and November 2018, analyzing relationships between colonoscopy findings of a population screening program and various socioeconomic and demographic variables included in the study (sex, age, place of residence, average annual income, unemployment rate, etc.), and determining any association between such factors and related increases in adenocarcinoma risk. A total of 1422 patients were included in the study. The difference in participation according to sex was greater in rural population (63,4% men/36,6% women in rural areas, 58% men/42% women in urban areas). The mean delayed diagnosis was 59,26 days in both groups. Adenocarcinoma risk was 1.216 times higher in rural population. High-grade dysplasic lesions and adenocarcinoma were more common in municipalities with income < 9000€. However, advanced stage adenocarcinoma was higher in municipalities with income > 9000€. Adenocarcinoma risk was 1,088 times higher in municipalities with an unemployment rate of > 10%. Living in rural areas is not a barrier to access to health care, with no disadvantages identified regarding diagnosis and treatment, thanks to public health policies and the large number of small municipalities near the referral hospital in Cuenca.
Highlights
Cancer is a public health problem with a significant social impact [1, 2]
The study population comprised all individuals in the province of Cuenca that had undergone a colonoscopy at the Virgen de la Luz Hospital, the only referral hospital in the Cuenca Healthcare Area, following a positive fecal occult blood test (FOBT) test conducted as part of the population screening program for colorectal cancer between May 2015 and November 2018
We found the number of colonoscopies performed was lower in women from both urban and rural areas, with the difference being more notable in rural settings, which is inconsistent with the findings of previous studies [2]
Summary
Cancer is a public health problem with a significant social impact [1, 2]. CRC is the third most common cancer and the second most deadly worldwide, accounting for 700,000 deaths per year [3]. The primary risk factor for colorectal cancer is age, with 90% of cases occurring in adults aged 50 or over [6]. The increased life expectancy with cancer can be explained by improvements in social and working conditions, early detection, higher levels of education and greater media information. This increase in life expectancy has led to a rise in neoplasm risk [7]
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