Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care

Murage, Peninah, Murchie, Peter, Bachmann, Max ORCID: https://orcid.org/0000-0003-1770-3506, Crawford, Michael and Jones, Andy (2017) Impact of travel time and rurality on presentation and outcomes of symptomatic colorectal cancer: a cross-sectional cohort study in primary care. British Journal of General Practice, 67 (660). e460-e466. ISSN 0960-1643

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Abstract

Background: Several studies have reported a survival disadvantage for rural dwellers who develop colorectal cancer, but the underlying mechanisms remain obscure. Delayed presentation to GPs may be a contributory factor, but evidence is lacking. Aim: To examine the association between rurality and travel time on diagnosis and survival of colorectal cancer in a cohort from northeast Scotland. Design and setting: The authors used a database linking GP records to routine data for patients diagnosed between 1997 and 1998, and followed up to 2011. Method: Primary outcomes were alarm symptoms, emergency admissions, stage, and survival. Travel time in minutes from patients to GP was estimated. Logistic and Cox regression were used to model outcomes. Interaction terms were used to determine if travelling time impacted differently on urban versus rural patients. Results: Rural patients and patients travelling farther to the GP had better 3-year survival. When the travel outcome associations were explored using interaction terms, the associations differed between rural and urban areas. Longer travel in urban areas significantly reduced the odds of emergency admissions (odds ratio [OR] 0.62, P<0.05), and increased survival (hazard ratio 0.75, P<0.05). Longer travel also increased the odds of presenting with alarm symptoms in urban areas; this was nearly significant (OR 1.34, P = 0.06). Presence of alarm symptoms reduced the likelihood of emergency admissions (OR 0.36, P<0.01). Conclusion: Living in a rural area, and travelling farther to a GP in urban areas, may reduce the likelihood of emergency admissions and poor survival. This may be related to how patients present with alarm symptoms.

Item Type:	Article
Uncontrolled Keywords:	access,cancer symptoms,early diagnosis,geography,primary care,rurality,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care Faculty of Medicine and Health Sciences > Research Centres > Business and Local Government Data Research Centre (former - to 2023) Faculty of Medicine and Health Sciences > Research Groups > Health Promotion Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023) Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Population Health
Related URLs:	http://bjgp.org/lookup/doi/10.3399/bjgp1...
Depositing User:	Pure Connector
Date Deposited:	31 Jan 2017 02:16
Last Modified:	12 Dec 2023 01:12
URI:	https://ueaeprints.uea.ac.uk/id/eprint/62221
DOI:	10.3399/bjgp17X691349

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