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Article

Spatial Variation of Survival for Colorectal Cancer in Malaysia

1
Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
2
Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
3
Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool FY3 8NR, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2021, 18(3), 1052; https://doi.org/10.3390/ijerph18031052
Received: 5 November 2020 / Revised: 15 January 2021 / Accepted: 19 January 2021 / Published: 25 January 2021
(This article belongs to the Section Public Health Statistics and Risk Assessment)
A patient’s survival may depend on several known and unknown factors and it may also vary spatially across a region. Socioeconomic status, accessibility to healthcare and other environmental factors are likely to contribute to survival rates. The aim of the study was to model the spatial variation in survival for colorectal cancer patients in Malaysia, accounting for individual and socioeconomic risk factors. We conducted a retrospective study of 4412 colorectal cancer (ICD-10, C18-C20) patients diagnosed from 2008 to 2013 to model survival in CRC patients. We used the data recorded in the database of the Malaysian National Cancer Patient Registry-Colorectal Cancer (NCPR-CRC). Spatial location was assigned based on the patients’ central district location, which involves 144 administrative districts of Malaysia. We fitted a parametric proportional hazards model in which the spatially correlated frailties were modelled by a log-Gaussian stochastic process to analyse the spatially referenced survival data, which is also known as a spatial survival model. After controlling for individual and area level characteristics, our findings indicate wide spatial variation in colorectal cancer survival across Malaysia. Better healthcare provision and higher socioeconomic index in the districts where patients live decreased the risk of death from colorectal cancer, but these associations were not statistically significant. Reliable measurement of environmental factors is needed to provide good insight into the effects of potential risk factors for the disease. For example, a better metric is needed to measure socioeconomic status and accessibility to healthcare in the country. The findings provide new information that might be of use to the Ministry of Health in identifying populations with an increased risk of poor survival, and for planning and providing cancer control services. View Full-Text
Keywords: colorectal cancer; survival; spatial survival; spatial modelling colorectal cancer; survival; spatial survival; spatial modelling
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MDPI and ACS Style

Ghazali, A.K.; Keegan, T.; Taylor, B.M. Spatial Variation of Survival for Colorectal Cancer in Malaysia. Int. J. Environ. Res. Public Health 2021, 18, 1052. https://doi.org/10.3390/ijerph18031052

AMA Style

Ghazali AK, Keegan T, Taylor BM. Spatial Variation of Survival for Colorectal Cancer in Malaysia. International Journal of Environmental Research and Public Health. 2021; 18(3):1052. https://doi.org/10.3390/ijerph18031052

Chicago/Turabian Style

Ghazali, Anis K., Thomas Keegan, and Benjamin M. Taylor. 2021. "Spatial Variation of Survival for Colorectal Cancer in Malaysia" International Journal of Environmental Research and Public Health 18, no. 3: 1052. https://doi.org/10.3390/ijerph18031052

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