Sex differences in hospital readmission among colorectal cancer patients

Abstract

Background: While several studies have analysed sex and socioeconomic differences in cancer incidence and mortality, sex differences in oncological health care have been seldom considered. Objective: To investigate sex based inequalities in hospital readmission among patients diagnosed with colorectal cancer. Design: Prospective cohort study. Setting: Hospital Universitary in L'Hospitalet (Barcelona, Spain). Participants: Four hundred and three patients diagnosed with colorectal between January 1996 and December 1998 were actively followed up until 2002. Main outcome measurements and methods: Hospital readmission times related to colorectal cancer after surgical procedure. Cox proportional model with random effect (frailty) was used to estimate hazard rate ratios and 95% confidence intervals of readmission time for covariates analysed. Results: Crude hazard rate ratio of hospital readmission in men was 1.61 (95% CI 1.21 to 2.15). When other significant determinants of readmission were controlled for (including Dukes's stage, mortality, and Charlson's index) a significant risk of readmission was still present for men (hazard rate ratio: 1.52, 95% CI 1.17 to 1.96). Conclusions: In the case of colorectal cancer, women are less likely than men to be readmitted to the hospital, even after controlling for tumour characteristics, mortality, and comorbidity. New studies should investigate the role of other non-clinical variable such as differences in help seeking behaviours or structural or personal sex bias in the attention given to patients.

Factors Associated With Unplanned Hospitalizations Among Patients With Nonmetastatic Colorectal Cancers Intended for Treatment in the Ambulatory Setting

“…Reports from single institution-based studies in patients with colorectal cancer indicate that higher (stages III and IV) disease stage, receipt of chemotherapy or radiation therapy, multiple (three or more) comorbidities, and inadequate support in the home are associated with unplanned hospitalizations (González et al, 2005; Hassett et al, 2011; Weaver et al, 2006). …”

“…Females receiving chemotherapy for colorectal cancers have been noted to experience higher rates of myelosuppression, diarrhea and mucositis in several studies (González et al, 2005; Nottage et al, 2003; Pal & Hurria, 2010; Sloan et al, 2002; Zalcberg, Kerr, Seymour, & Palmer, 1998). This may be related to biologic differences in clearance of 5-fluorouracil—the most commonly administered drug—though the exact mechanism underlying this observation is unclear.…”

frailtypack: AnRPackage for the Analysis of Correlated Survival Data with Frailty Models Using Penalized Likelihood Estimation or Parametrical Estimation

“…The objective of the study described in Gonzalez et al (2005) is to analyse the hospital readmission times related to colorectal cancer after surgical procedure. We first estimate the hazard rate ratios of readmission time for covariates analysed using a Cox proportional model, then using a shared frailty model and finally using a joint frailty model.…”

Semiparametric inference for a general class of models for recurrent events

“…There were a total of 861 rehospitalization events recorded for the 403 patients included in the analysis. This data set was analyzed in Gonzalez et al (2005) using a gamma frailty model, which corresponds to the general model with . Their goal being to determine whether there were differences regarding the time of the recurrent hospitalization due to social-demographic or clinical outcomes.…”