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Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis
  1. Louise Hayes1,
  2. Jean Adams2,
  3. Iain McCallum3,
  4. Lynne Forrest4,
  5. Mira Hidajat5,
  6. Martin White2,
  7. Linda Sharp1
  1. 1 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  3. 3 Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  4. 4 University of Edinburgh School of GeoSciences, Edinburgh, UK
  5. 5 University of Bristol School of Social and Community Medicine, Bristol, UK
  1. Correspondence to Linda Sharp, Population Health Sciences Institute Newcastle University Royal Victoria Infirmary, Newcastle University, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK;{at}


Background Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer.

Methods We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18–C20; n=35 142) diagnosed in the period 2001–2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile.

Results 48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60–69, 70–79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91).

Conclusions Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.

  • Cancer
  • Inequalities
  • Registers

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  • Contributors LH undertook the data analyses and co-wrote the paper; LS: advised on the data analysis and co-wrote the paper; JA, IM, LF, MH and MW contributed to the study design, supervision and interpretation of data, and commented critically on manuscript drafts.

  • Funding This study was supported by the National Institute for Health Research (NIHR) School for Public Health Research (grant reference numbers: SPHR-SWP-AGP-PR3 and PD-SPH-2015), of which Fuse is a member. Fuse is a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Fuse received funding from British Heart Foundation, Cancer Research UK, National Institute of Health Research, Economic and Social Research Council, Medical Research Council, Health and Social Care Research and Development Office, Northern Ireland, National Institute for Social Care and Health Research (Welsh Assembly Government) and the Wellcome Trust, under the auspices of the UKCRC.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. At the time of the data request, the SPHR was a partnership between the Universities of Sheffield, Bristol, Cambridge; UCL; The London School for Hygiene and Tropical Medicine; The Peninsula College of Medicine and Dentistry; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data used in the study are not owned by the authors. They were released by the data controller to the authors solely for the purpose of the research study and the authors do not have permission to share them with others. Public Health England is the current data controller and data for the same population may be requested through PHE’s Office of Data Release.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.