Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study

Figures & data

Table 1 Distribution and Frequency of Patient and Tumor Factors for the Top Five Comorbidities Plus Dementia by Patient and Tumor Factors Among Colorectal Cancer Patients at Diagnosis in Granada and Girona, 2011, n = 1061

	Total	Congestive Heart Failure		Peripheral Vascular Disease		Dementia		COPD		Rheumatic Disease		Diabetes Mellitus
		n	%	n	%	n	%	n	%	n	%	n	%
Patient’s Factors
Age in Years
<55	130	4	3.1	9	6.9	2	1.5	8	6.2	6	4.6	6	4.6
55–64	219	17	7.8	22	10.1	5	2.3	21	9.7	13	6.0	42	19.4
65–74	272	34	12.6	36	13.4	5	1.9	57	21.0	30	11.2	86	32.0
≥75	440	99	23.3	57	13.4	36	8.5	96	23.0	55	12.9	116	27.3
Sex
Male	644	96	15.2	76	12.0	21	3.3	143	23.0	42	6.7	171	27.1
Female	417	58	14.1	48	11.7	27	6.6	39	9.5	62	15.1	79	19.3
Performance Status
Normal (0)	259	20	7.8	12	4.7	1	0.4	25	9.7	19	7.4	45	17.5
Restricted but able to carry out light work (1)	423	68	16.1	62	14.7	13	3.1	89	21.0	66	15.6	117	27.7
Restricted, unable to work but capable of self-care (2)	83	21	25.6	10	12.2	8	9.8	16	20.0	9	11.0	25	30.5
Restricted, capable of limited self-care (3)	35	12	34.3	9	25.7	6	17.1	8	23.0	4	11.4	14	40.0
Disabled (4)	6	4	66.7	2	33.3	2	33.3	2	33.0	2	33.3	1	16.7
Smoking Status
Current	130	12	9.2	15	11.5	5	3.8	35	27.0	9	6.9	31	23.8
Previous	298	55	18.5	35	11.7	9	3.0	80	27.0	16	5.4	87	29.2
Never	505	68	13.5	65	12.9	25	5.0	54	11.0	67	13.3	104	20.6
BMI in kg/m^2
<25	226	17	7.5	23	10.2	12	5.3	40	18.0	22	9.7	40	17.7
25.0–29.9	327	40	12.2	42	12.8	10	3.1	41	13.0	25	7.6	74	22.7
≥30	193	30	15.5	33	17.1	7	3.6	49	25.0	21	10.9	60	31.1
Tumor Factors
Anatomical Site
Right Colon	357	55	15.7	44	12.5	21	6.0	67	19.1	31	8.8	98	28.8
Left Colon	340	50	14.9	41	12.2	11	3.3	63	18.8	33	9.9	74	22.1
Rectal	353	47	13.5	38	10.9	16	4.6	51	14.7	39	11.2	76	21.8
Colon Unspecified	11	2	28.6	1	14.3	0	-	1	14.3	1	14.3	2	28.6
Grade
I	168	24	15.2	19	12.0	3	1.9	21	13.3	19	12.0	36	22.8
II	596	83	14.0	77	13.0	27	4.6	116	19.5	56	9.4	138	23.3
III	90	13	14.6	7	7.9	2	2.2	12	13.5	8	9.0	30	33.7
IV	7	1	14.3	0	-	1	14.3	0	-	1	14.3	0	-
Stage
I	168	25	15.0	18	10.8	6	3.6	23	13.8	17	10.2	34	20.4
II	281	51	18.4	31	11.2	13	4.7	57	20.6	42	15.2	69	25.0
III	285	29	10.4	39	13.9	11	3.9	54	19.3	16	5.7	79	28.2
IV	267	43	16.2	34	12.8	13	4.9	37	14.0	28	10.6	54	20.4

Table 2 Patient and Tumor Factors Associated with Higher Prevalence of Comorbidity (One) and Multimorbidity (Two or More Comorbidities) Among Colorectal Cancer Patients at Diagnosis in Granada and Girona, 2011, n = 1061

	Total	One Comorbidity vs None			Multimorbidity: 2 or More vs None
		n(%)	CPR (95% CI)	APR (95% CI)	n(%)	CPR (95% CI)	APR (95% CI)
Patient’s Factors
Age in Years
<55	130	25 (19.3)	(Reference)	(Reference)	11 (8.5)	(Reference)	(Reference)
55–64	216	63 (29.2)	2.0 (1.2, 3.4)	2.0 (1.2, 3.4)	35 (16.2)	2.5 (1.2, 5.3)	2.4 (1.2, 5.1)
65–74	269	82 (30.5)	3.3 (1.9, 5.6)	3.2 (1.9, 5.5)	93 (34.6)	8.5 (4.3, 16.8)	8.2 (4.1, 16.3)
≥75	423	131 (31.0)	4.6 (2.8, 7.6)	4.6 (2.7, 7.7)	185 (43.7)	14.8 (7.6, 28.8)	14.9 (7.6, 29.2)
Sex
Male	630	183 (29.0)	(Reference)	(Reference)	215 (34.1)	(Reference)	(Reference)
Female	408	118 (28.9)	0.8 (0.6, 1.1)	0.8 (0.6, 1.1)	109 (26.7)	0.6 (0.5, 0.9)	0.6 (0.4, 0.8)
Performance Status (ECOG)
Normal (0)	257	59 (23.0)	(Reference)	(Reference)	40 (15.6)	(Reference)	(Reference)
Restricted but able to carry out light work (1)	422	137 (32.5)	2.8 (1.9, 4.1)	2.5 (1.7, 3.7)	154 (36.5)	4.6 (3.1, 7.1)	2.0 (0.9, 4.6)
Restricted, unable to work but capable of self-care (2)	82	25 (30.5)	3.2 (1.7, 6.1)	2.3 (1.1, 4.6)	36 (43.9)	6.8 (3.6, 12.8)	7.0 (3.3, 14.9)
Restricted, capable of limited self-care or disabled (3, 4)	40	11 (27.5)	7.4 (2.3, 24.0)	5.9 (1.7, 19.6)	25 (62.5)	24.7 (8.1, 75.0)	9.4 (4.5, 19.7)
Smoking Status
Current	130	42 (32.3)	1.3 (0.8, 2.1)	2.1 (1.3, 3.6)	40 (30.1)	1.3 (0.8, 2.1)	2.7 (1.6, 4.8)
Previous	297	89 (30.0)	1.4 (1.0, 2.0)	1.6 (1.0, 2.5)	113 (38.0)	1.9 (1.3, 2.7)	2.2 (1.4, 3.4)
Never	503	145 (28.8)	(Reference)	(Reference)	137 (27.2)	(Reference)	(Reference)
BMI in kg/m^2
<25	226	72(31.9)	(Reference)	(Reference)	57(25.2)	(Reference)	(Reference)
25.0–29.9	326	87(26.7)	0.8 (0.5, 1.2)	0.8 (0.5, 1.2)	89(27.3)	1.0 (0.7, 1.5)	1.0 (0.6, 1.6)
≥30	193	52(26.9)	1.1 (0.7, 1.8)	1.2 (0.7, 1.9)	79(40.9)	2.2 (1.4, 3.5)	2.4 (1.4, 4.0)
Tumor Factors
Anatomical Site
Right Colon	357	102(29.3)	(Reference)	(Reference)	118(33.9)	(Reference)	(Reference)
Left colon	340	93(27.8)	1.1 (0.7, 1.5)	0.9 (0.6, 1.3)	104(31.0)	1.3 (0.9, 1.9)	0.8 (0.6, 1.2)
Rectal	353	106(30.5)	0.9 (0.6, 1.3)	1.0 (0.7, 1.4)	99(28.5)	1.1 (0.8, 1.6)	0.8 (0.5, 1.1)
Grade
I	158	48(30.4)	(Reference)	(Reference)	44(27.8)	(Reference)	(Reference)
II	592	169(28.6)	1.0 (0.6, 1.5)	0.9 (0.6, 1.3)	189(31.9)	1.2 (0.8, 1.9)	1.0 (0.6, 1.6)
III-IV	96	27(28.1)	0.9 (0.5, 1.6)	0.8 (0.4, 1.4)	27(28.1)	1.0 (0.5, 1.8)	0.8 (0.4, 1.6)
Stage
I	167	46(27.5)	(Reference)	(Reference)	47(28.1)	(Reference)	(Reference)
II	276	85(30.1)	1.5 (0.9, 2.4)	1.3 (0.8, 2.1)	99(35.9)	1.7 (1.0, 2.7)	1.3 (0.8, 2.1)
III	279	76(27.2)	1.1 (0.7, 1.7)	1.0 (0.6, 1.7)	89(31.9)	1.2 (0.8, 1.9)	1.1 (0.7, 1.8)
IV	265	85(32.1)	1.3 (0.8, 2.0)	1.2 (0.7, 1.9)	72(27.2)	1.0 (0.7, 1.7)	0.9 (0.5, 1.5)

Notes: Age was adjusted for sex and sex was adjusted for age. Complete case analysis: there were 20 (1.9%) missing values for comorbidities; 256 (24.1%) for performance status; 128 (12.0%) for smoking status; 315 (26.7%) for BMI, and 60 (5.7%) for stage.

Abbreviations: CPR, crude prevalence ratio; APR, adjusted for age and sex prevalence ratio.

Figure 1 Distribution of the time from colorectal cancer diagnosis to surgery by comorbidities status among all incident colorectal cancer patients in Granada and Girona, 2011, n = 1061 ((A): Histogram and kernel density and (B): Box plot).

Figure 2 Mean nonparametric estimated time-to-surgery by patients’ comorbidity status, age and cancer stage, in Granada and Girona, 2011, n = 1061.

Table 3 Nonparametric Regression Estimates from Time-to-Surgery by Patients’ Comorbidity Status, Age and Cancer Stage in Spain 2011, n = 1061

Variables	Estimated CMD	95% CI*
Comorbidities
None	Reference	Reference
One	5.24	(−1.31, 11.65)
Two or more	16.74	(3.23, 29.42)
Age in years
For one-unit increase	−1.11	(−1.6, −0.80)
Cancer Stage
I	Reference
II	−5.31	(−10.68, 0.58)
III	0.51	(−8.43, 10.42)
IV	1.22	(−12.30, 17.35)

Notes: Bold figures highlight statistically significant values (i.e., it does not include the zero). *Bootstrapped 95% confidence intervals.

Abbreviation: CMD, conditional mean difference from time-to-surgery.