Spatial patterns of colorectal cancer survival rates in Malaysia, 2013-2018.

Abstract

Large geographical variations in colorectal cancer (CRC) survival rates have been reported across regions. Poorer survival rates were mainly found in socioeconomically deprived areas, highly dense areas, and areas lacking healthcare accessibility. The objective of this study was to identify, compare, and contrast the spatial patterns of 5-year CRC-specific survival rates and identify high-priority areas by districts in Malaysia. This retrospective cohort study utilized secondary data from the National Cancer Registry. CRC patients (ICD10 C18-21) diagnosed between 2013 and 2018 were selected. Patient addresses were geocoded into districts and states via geospatial data from the National Geospatial Centre, whereas district population density data were gathered from the Population Census of Malaysia. Kaplan‒Meier survival analysis and log-rank test were conducted to determine and compare the 5-year CRC-specific survival rates, and the spatial distribution of CRC survival by district was determined via ArcGIS software. A total of 18,513 CRC patients were registered from 143 districts, with 10,819 deaths occurring during follow-up. The national 5-year CRC-specific survival rate was 42%, with median survival time of 36months (95% CI: 34.46, 37.54). The eastern region (Kelantan, Terengganu, and Pahang) had the lowest survival (38.0%). Among the 143 districts, eighty-one (56.6%) reported survival rates below the national average while thirty-six (25.2%) were identified as high-priority districts. The differences in CRC survival rates were evident according to geographical location. Area-based targeted interventions to improve CRC detection, management, and access to healthcare are imperative to address cancer survival disparities and help effectively allocate resources.