Disparities in the Diagnosis and Treatment of Gastric Cancer in Relation to Disabilities.

introductionWe investigated potential disparities in the diagnosis, treatment, and survival of gastric cancer (GC) patients with and without disabilities.

methodsWe linked Korean National Disability Registry data with the Korean National Health Insurance database and Korean Central Cancer Registry data. This study included a total of 16,849 people with disabilities and 58,872 age- and sex-matched control subjects in whom GC had been diagnosed.

resultsWhen compared to GC patients without disabilities, patients with disabilities tended to be diagnosed at a later stage (localized stage 53.7% vs 59.0% or stage unknown 10.7% vs 6.9%), especially those with severe disabilities (P < 0.001). This was more evident in patients with mental impairment (localized stage 41.7% and stage unknown 15.2%). In addition, not receiving treatment was more common in patients with disabilities than those without disabilities (29.3% vs 27.2%, P < 0.001), and this disparity was more evident in those with severe disabilities (35.4%) and in those with communication (36.9%) and mental (32.3%) impairment. Patients with disabilities were at slightly higher risk of overall mortality as well as GC-specific mortality compared to people without disabilities (adjusted hazard ratio [aHR] = 1.18, 95% confidence interval: 1.14-1.21 and aHR = 1.12, 95% confidence interval: 1.09-1.16, respectively), and these disparities were more pronounced in those with severe disabilities (aHR = 1.62 and 1.51, respectively). DISCUSSION: Patients with disabilities, especially severe disabilities, were diagnosed with GC at a later stage, received less staging evaluation and treatment, and their overall survival rate was slightly worse compared to those without disabilities.