Uneven Between-Hospital Distribution of Patient-Related Risk Factors for Adverse Outcomes of Colorectal Cancer Treatment: A Population-Based Register Study

Figures & data

Figure 1 Definition of cohort for analyses and coupling of data.

Table 1 Characteristics of 44,471 Patients with Colorectal Cancer Diagnosed in the Years 2009–2018 in Denmark

	Frequency	Percent
Age group
<50	1734	4
50–64	10,091	23
65–74	15,861	36
75–84	12,428	28
85+	4357	10
Gender
Male	24,205	54
Female	20,266	46
UICC stage
I	6713	15
II	11,170	25
III	9679	22
IV	10,626	24
Unknown	6283	14
Location of cancer
Colon	30,149	68
Rectum	14,322	32
ASA score
I	8868	20
II	22,109	50
III	9908	22
IV+V	987	2
Unknown	2599	6
WHO performance status
0	13,857	31
1	5779	13
2	2287	5
3+4	1159	3
Unknown	21,389	48
Charlson score
0	32,011	72
1	3834	9
2	5107	11
3+	3519	8
Smoking status
Active smoker	7501	17
Ex-smoker	15,002	34
Never smoker	14,718	33
Unknown	7250	16
Body mass index class
Underweight	1415	3
Normal	17,406	39
Overweight	14,283	32
Obese	6665	15
Unknown	4702	11
Alcohol consumed per week (units^a)
0–14	32,753	74
15+	4887	11
Unknown	6831	15
Highest educational level
Short	16,315	37
Medium	18,993	43
Long	7356	17
Unknown	1807	4
Participation in screening
Yes	7486	17
No	2915	7
Not invited	34,070	77
Cohabitation status
Cohabiting	26,103	59
Alone	18,308	41
Unknown	60	0

Note: ^aOne unit = 2 grams of pure ethanol.

Abbreviations: UICC, Union for international Cancer Control; ASA, American Society of Anesthesiologists; WHO, World Health Organization.

Figure 2 Distribution of demographics, performance score, lifestyle, participation in screening, socioeconomic and disease-related factors in a Danish cohort of patients with colorectal cancer. Hospitals ordered by patient volume, from low (left) to high volume (right).

Figure 3 Prevalence of somatic and psychiatric comorbidities in a Danish cohort of colorectal cancer patients. Hospitals ordered by patient volume, from low (left) to high volume (right).

Table 2 Multiple Logistic Regressions of 30 Day Postoperative Surgical and Medical Complications and 90 Day Postoperative Mortality, Adjusted for Patient-Related Risk Factors

	Medical Complications		Surgical Complications		90 Day Mortality
	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI
Age group (ref. <50)
50–64	1.02	[0.76, 1.36]	1.02	[0.88, 1.19]	0.85	[0.53, 1.37]
65–74	1.32	[0.99, 1.75]	0.89	[0.77, 1.04]	1.33	[0.85, 2.11]
75–84	1.89	[1.42, 2.52]	0.87	[0.75, 1.02]	2.08	[1.32, 3.29]
85+	2.42	[1.78, 3.29]	0.75	[0.62, 0.91]	3.08	[1.91, 4.97]
Gender (ref. Male)
Female	0.67	[0.61, 0.73]	0.66	[0.62, 0.70]	0.73	[0.64, 0.84]
UICC stage (ref. I)
II	1.22	[1.08, 1.37]	1.07	[0.98, 1.16]	1.11	[0.91, 1.37]
III	1.20	[1.06, 1.36]	1.08	[0.99, 1.18]	1.34	[1.08, 1.65]
IV	1.32	[1.14, 1.53]	0.99	[0.90, 1.10]	4.27	[3.47, 5.25]
Unknown	1.27	[1.06, 1.52]	1.10	[0.98, 1.25]	2.64	[2.00, 3.50]
Location of cancer (ref. Colon)
Rectum	1.12	[1.02, 1.22]	1.66	[1.56, 1.76]	1.00	[0.87, 1.14]
ASA score (ref. I)
II	1.38	[1.20, 1.59]	1.30	[1.20, 1.42]	1.89	[1.42, 2.50]
III	2.54	[2.15, 2.98]	1.55	[1.40, 1.73]	3.89	[2.89, 5.24]
IV+V	5.03	[3.74, 6.76]	1.62	[1.28, 2.06]	9.80	[6.62,14.51]
Unknown	1.48	[1.00, 2.18]	1.12	[0.85, 1.48]	3.05	[1.90, 4.90]
WHO performance score (ref. 0)
1	1.08	[0.95, 1.23]	1.02	[0.92, 1.12]	1.72	[1.33, 2.22]
2	1.40	[1.17, 1.67]	1.09	[0.94, 1.27]	2.74	[2.05, 3.66]
3+4	1.37	[1.02, 1.86]	1.13	[0.88, 1.45]	5.57	[3.88, 8.02]
Unknown	0.64	[0.55, 0.76]	0.83	[0.74, 0.92]	2.01	[1.52, 2.67]
Cardiovascular disease	1.09	[0.99, 1.21]	1.00	[0.93, 1.07]	1.26	[1.08, 1.47]
Chronic pulmonary disease	1.31	[1.19, 1.43]	1.08	[1.01, 1.15]	1.13	[0.99, 1.29]
Diabetes	1.00	[0.89, 1.12]	0.99	[0.91, 1.07]	1.04	[0.89, 1.23]
Dementia	0.92	[0.67, 1.25]	0.91	[0.71, 1.15]	1.45	[1.04, 2.02]
Liver disease	1.08	[0.73, 1.60]	1.15	[0.87, 1.53]	2.06	[1.28, 3.30]
Kidney disease	1.50	[1.22, 1.86]	1.30	[1.08, 1.56]	1.34	[1.00, 1.79]
Nerve disease	1.10	[0.77, 1.56]	0.90	[0.67, 1.20]	1.47	[0.96, 2.27]
Other cancer	0.91	[0.80, 1.03]	0.97	[0.89, 1.07]	1.12	[0.94, 1.33]
Connective tissue disease	1.16	[1.01, 1.32]	0.99	[0.89, 1.10]	1.16	[0.95, 1.41]
Affective disorder	1.15	[1.04, 1.27]	1.09	[1.02, 1.18]	1.17	[1.01, 1.35]
Schizophrenic spectrum disorder	1.49	[0.90, 2.48]	1.54	[1.08, 2.20]	2.44	[1.36, 4.39]
Disorder of adult personality and behaviour	0.54	[0.22, 1.37]	0.70	[0.42, 1.18]	0.84	[0.26, 2.79]
Psychoactive drug abuse disorder	1.29	[1.07, 1.55]	1.15	[1.01, 1.32]	1.04	[0.79, 1.38]
Smoking status (ref. Non-smoker)
Active smoker	1.20	[1.06, 1.35]	1.25	[1.15, 1.36]	1.12	[0.93, 1.36]
Ex-smoker	1.13	[1.03, 1.25]	1.18	[1.11, 1.27]	0.98	[0.84, 1.14]
Unknown	1.00	[0.82, 1.22]	1.14	[1.00, 1.31]	1.27	[0.96, 1.68]
Body mass index class (ref. Normal weight)
Underweight	1.21	[0.97, 1.52]	1.00	[0.84, 1.19]	1.94	[1.50, 2.52]
Overweight	0.99	[0.90, 1.08]	1.09	[1.02, 1.16]	0.69	[0.59, 0.80]
Obese	1.10	[0.98, 1.24]	1.33	[1.22, 1.44]	0.79	[0.65, 0.95]
Unknown	1.96	[1.60, 2.40]	1.62	[1.40, 1.88]	0.97	[0.76, 1.26]
Alcohol consumed per week (units^a) (ref. ≤14)
15+	1.09	[0.96, 1.23]	1.11	[1.02, 1.21]	1.12	[0.92, 1.38]
Unknown	1.49	[1.23, 1.80]	1.23	[1.07, 1.41]	1.34	[1.02, 1.75]
Highest educational level (ref. Long)
Short	1.12	[0.98, 1.29]	1.04	[0.95, 1.14]	0.99	[0.80, 1.23]
Medium	1.08	[0.95, 1.23]	1.04	[0.95, 1.13]	0.94	[0.76, 1.16]
Unknown	1.61	[1.27, 2.04]	1.17	[0.97, 1.41]	2.95	[2.23, 3.89]
Quartile of household income (ref. 4th)
1st	1.09	[0.95, 1.25]	1.02	[0.93, 1.13]	1.29	[1.03, 1.61]
2nd	1.03	[0.91, 1.18]	1.00	[0.91, 1.09]	1.24	[1.00, 1.55]
3rd	0.98	[0.87, 1.12]	1.05	[0.97, 1.14]	1.04	[0.83, 1.29]
Unknown	0.36	[0.09, 1.49]	0.61	[0.32, 1.16]	0.31	[0.04, 2.34]
Cohabitation status (ref. Cohabiting)
Alone	1.00	[0.91, 1.09]	1.00	[0.94, 1.07]	1.06	[0.93, 1.21]
Unknown	3.11	[0.53,18.37]	2.17	[0.83, 5.67]	1.41	[0.08,24.26]
Year of diagnosis	0.86	[0.84, 0.89]	0.89	[0.88, 0.91]	0.94	[0.90, 0.98]
Participation in screening (ref. Yes)
No	0.98	[0.81, 1.19]	1.22	[1.07, 1.39]	1.38	[0.96, 2.00]
Not invited	0.89	[0.78, 1.01]	1.00	[0.91, 1.10]	1.44	[1.08, 1.92]
Intercept	0.09	[0.06, 0.13]	0.29	[0.22, 0.38]	0.00	[0.00, 0.01]

Notes: ^aOne unit = 2 grams of pure ethanol. Goodness of fit tests p-values respectively: Medical Complications= 0.81; Surgical Complications= 0.6; 90-day Mortality= 0.52.

Abbreviations: UICC, Union for international Cancer Control; ASA, American Society of Anesthesiologists; WHO, World Health Organization.

Figure 4 Predicted and observed frequencies of postoperative medical and surgical complications, and 90-day postoperative mortality, in a Danish cohort of patients with colorectal cancer. Hospitals ordered by patient volume, from low (left) to high volume (right).