Abstract
This study aimed to evaluate whether stage at cancer diagnosis of older adult differed depending on their disabilities. Using a dataset linking the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database, we established age- and sex-matched cohort with a 1:3 ratio of 2,776,450 people with disabilities and 8,329,350 people without disabilities. Older patients over 65 diagnosed with cancer were subsequently selected from this cohort. Cancer stage at diagnosis was defined as local, regional, distant, and unknown based on the Surveillance, Epidemiology, and End Results (SEER) summary. Multivariable logistic regression analysis was performed to estimate the risk of each stage after adjusting for age, sex, income, residential area, and Charlson comorbidity index. Compared to older cancer patients with no disability, older patients with disabilities showed significantly higher risks of being diagnoses at a distant stage for liver cancer (adjusted odds ratio [OR] 1.09, 95% CI 1.001–1.188), or a unknown stage for lung (1.095, 1.022–1.173), liver (1.114, 1.027–1.208), colorectal (1.24, 1.141–1.347), breast (1.263, 1.005–1.588), cervix uteri (1.662, 1.271–2.174), pancreas (1.198, 1.045–1.374), and brain and central nervous system (1.298, 1.019–1.652) cancer. The risk was especially marked in the severe disability group or patients with brain or mental impairment. Older patients with disabilities, especially severe ones or patient with psychological/developmental difficulty, underwent less staging work-up. The cause of this difference needs to be addressed because it can be led to unequal for older patients with disabilities.