Impact of deprivation on short- and long-term outcomes after colorectal cancer surgery

Background: The aim of the study was to determine the association between short- and long-term outcomes and deprivation for patients undergoing operative treatment for colorectal cancer in the Northern Region of England. Methods: This was a retrospective analytical study based on the Northern Region Colorectal Cancer Audit Group database for the period 1998-2002. The Index of Multiple Deprivation 2004, an area-based measure, was recalibrated and used to quantify deprivation. Patients were ranked based on their postcode of residence and grouped into five categories. Results: Of 8159 patients in total, 7352 (90.1 per cent) had surgery; 6953 (94.6 per cent) of the 7352 patients underwent tumour resection and 4935 (67.7 per cent) of 7294 had a margin-negative (R0) resection. Deprivation was not associated with age, sex, tumour site, stage or other tumour-related factors. Compared with the most affluent group, the most deprived patients had fewer elective operations (72.9 versus 76.4 per cent; P = 0.014), more adverse co-morbidity (P < 0.001) and fewer curative resections (65.5 versus 71.2 per cent; P < 0.001). In multivariable analysis, deprivation was not an independent predictor of postoperative death (odds ratio (OR) 0.72, 95 per cent confidence interval 0.48 to 1.06; P = 0.101) but it was a predictor of curative resection (OR 1.24, 1.01 to 1.52; P = 0.042), overall survival (HR 0.83, 0.73 to 0.95; P = 0.006) and relative survival (HR 0.74, 0.58 to 0.95; P = 0.023). Conclusion: Deprivation, both independently and by influencing other surgical predictors, impacts on short- and long-term outcomes of patients with colorectal cancer.