Table 3.

Results’ summary of the impact of healthcare utilization on stage at CRC diagnosis

Author	Measure	Relationship between comorbidity and stage at diagnosis
Fisher, 2004 [18]	Usual source of care	Individuals with a usual source of care (i.e., clinic or physician’s office) were less likely to be diagnosed at a later stage (OR: 0.4, 95% CI: 0.2–0.6)
Gross, 2006 [13]	Number of physician visits	A decreasing number of physician visits, prior to diagnosis, was associated with a later stage at diagnosis (p <0.001)
Roetzheim, 1999 [21]	Physician supply	For each 10 percentile increase in primary care physician supply, the odds of late-stage diagnosis decreased by 5% (OR: 0.95, 95% CI: 0.92–0.99) For each 10 percentile increase in specialty physician supply, the odds of late-stage diagnosis increased by 5% (OR: 1.05, 95% CI: 1.02–1.09)
Mitchell, 2007 [19]	ERP	Of all individuals who diagnosed with CRC via an emergency room presentation (ERP), a higher percentage of patients presented with Stage IV than Stage I (21.3% vs. 6.5%; p <0.001)
Polednak, 2000 [20]	ERP	ERP was associated with “distant” cancer diagnosis compared to all other stages (i.e., in situ, local, regional, unknown) (OR = 2.05, 95% CI: 1.82–2.30)