Associations of advanced age with comorbidity, stage and primary subsite as contributors to mortality from colorectal cancer

Kazzem Gheybi; Elizabeth Buckley; Agnes Vitry; David Roder

doi:10.3389/fpubh.2023.1101771

Associations of advanced age with comorbidity, stage and primary subsite as contributors to mortality from colorectal cancer

Front Public Health. 2023 Apr 6:11:1101771. doi: 10.3389/fpubh.2023.1101771. eCollection 2023.

Authors

Kazzem Gheybi^{1

2

3}, Elizabeth Buckley^{1

2}, Agnes Vitry⁴, David Roder^{1

2}

Affiliations

¹ University of South Australia Allied Health and Human Performance, Adelaide, SA, Australia.
² University of South Australia, Cancer Epidemiology and Population Health, Adelaide, SA, Australia.
³ Charles Perkins Centre, School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
⁴ University of South Australia Clinical and Health Sciences, Adelaide, SA, Australia.

Abstract

Background: Although survival from colorectal cancer (CRC) has improved substantially in recent decades, people with advanced age still have a high likelihood of mortality from this disease. Nonetheless, few studies have investigated how cancer stage, subsite and comorbidities contribute collectively to poor prognosis of older people with CRC. Here, we decided to explore the association of age with mortality measures and how other variables influenced this association.

Methods: Using linkage of several administrative datasets, we investigated the risk of death among CRC cases during 2003-2014. Different models were used to explore the association of age with mortality measures and how other variables influenced this association.

Results: Our results indicated that people diagnosed at a young age and with lower comorbidity had a lower likelihood of all-cause and CRC-specific mortality. Aging had a greater association with mortality in early-stage CRC, and in rectal cancer, compared that seen with advanced-stage CRC and right colon cancer, respectively. Meanwhile, people with different levels of comorbidity were not significantly different in terms of their increased likelihood of mortality with advanced age. We also found that while most comorbidities were associated with all-cause mortality, only dementia [SHR = 1.43 (1.24-1.64)], Peptic ulcer disease [SHR = 1.12 (1.02-1.24)], kidney disease [SHR = 1.11 (1.04-1.20)] and liver disease [SHR = 1.65 (1.38-1.98)] were risk factors for CRC-specific mortality.

Conclusion: This study showed that the positive association of advanced age with mortality in CRC depended on stage and subsite of the disease. We also found only a limited number of comorbidities to be associated with CRC-specific mortality. These novel findings implicate the need for more attention on factors that cause poor prognosis in older people.

Keywords: advanced age; cancer stage; colorectal cancer; comorbidity; mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / pathology
Comorbidity
Humans
Neoplasm Staging
Peptic Ulcer*
Risk Factors

Grants and funding

The research reported in this publication was supported by NHMRC Translational Research Project: 1133042, Eradicating preventable deaths from colorectal cancer – the Beat Bowel Cancer Project, and Australian National Data Service, Connecting registry data and administrative health data to combat colorectal cancer. This study was also supported by the Research Training Program and University President's Scholarships from the University of South Australia.