Use of the Taiwan''s National Health Insurance Research Databases to Investigate the Outcome of Emergency Department Treatment on the 3 year Survival Rate of Colorectal Cancer Patients and Other Factors

• Main Authors: Wei-Chun Hung, 洪偉君
• Other Authors: Li-Wen Lin
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/q8zxrk

碩士 === 義守大學 === 學士後中醫學系 === 107 === Background: The number of emergency department (ED) visits by patients with colorectal cancer (CRC) increased annually between 2000 and 2012 in Taiwan. However, how ED visits impacted the survival of those patients and whether the impact was affected by other factors are not completely understood. Therefore we conducted a nationwide cohort study to identify the predictors. Methods: We surveyed data for CRC patients from 2000 to 2012 using the Longitudinal Health Insurance Database 2000 (LHID2000) retrospectively, and then divided the subjects into an ED group and a non-ED group. Afterwards, we matched (1:1) the two groups on the basis of propensity scores (PS) and selected 1,289 patients for each group. Three-year survival was compared between the two groups by variable with the Cox proportional hazards model and the risk of mortality was represented by adjusted hazard ratio (aHR). The risk of all-cause mortalities was also calculated with the Cox model and illustrated by the Kaplan-Meier survival curves. The factors that interacted with ED visits in their impacts on the patients’ survival were identified based on the Cox model. Results: Mortality rates were higher in the ED group than the non-ED group among females (aHR =1.32 [1.05-1.66] ), those aged below 40 (aHR =7.21 [1.6-32.52] ), those visiting ED in level 1 hospitals (aHR =1.42 [1.14-1.77] ), those residing in north Taiwan (aHR =1.77 [1.38-2.26] ), those with surgery (aHR =2.66 [1.64-4.24] ), those with chemotherapy (aHR =1.79 [1.42-2.26] ), those at 3 to 4 stage (aHR =1.7 [1.32-2.18] ), and those without comorbidity (aHR =1.5 [1.22-1.85] ). Overall, the ED group had a higher risk of death than the non-ED group with the hazard ratio (HR) at 1.33 (1.14-1.54) in univariate analysis and 1.26 (1.09-1.47) in multivariate analysis. Statistically significant interaction was detected between ED visits and the following factors in their impacts on the 3-year survival: age (P=0.0003), geographic region (P=0.0009), surgery (P=0.0007), chemotherapy (P<0.0001), staging (P=0.0031) and comorbidity (P=0.0129). The 3-year cumulative survival of the non-ED group (0.7733) was higher than that of the ED group (0.6887). Conclusions: CRC patients with ED visits has poorer 3-year survival compared to those without ED visits, and the impact of ED visits on survival is closely associated with age, geographic region, surgery, chemotherapy, stage, and comorbidity. Emergency physicians should consider these factors to provide more intensive and specific medical services.