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. 2022 Nov 10;17(11):e0271929.
doi: 10.1371/journal.pone.0271929. eCollection 2022.

Colorectal cancer trends in Chile: A Latin-American country with marked socioeconomic inequities

Susana Mondschein  1   2 , Felipe Subiabre  1 , Natalia Yankovic  3 , Camila Estay  4 , Christian Von Mühlenbrock  4   5 , Zoltan Berger  4
Affiliations

Colorectal cancer trends in Chile: A Latin-American country with marked socioeconomic inequities

Susana Mondschein et al. PLoS One. .

Abstract

Introduction: Colorectal cancer (CRC) is the third most frequent malignant disease in the world. In some countries with established screening programs, its incidence and mortality have decreased, and survival has improved.

Aims: To obtain reliable data about the epidemiology of CRC in Chile, we analyzed the trends in the last ten years and the influence of observable factors on survival, including a nationwide health program for CRC treatment access (GES program).

Methods: Publicly available data published by the Ministry of Health and National Institute of Statistics were used. Data were obtained from registries of mortality and hospital discharges, making follow-up of the individuals possible. Crude and age-standardized incidence and mortality rates were calculated, and individual survival was studied by constructing Kaplan-Meier curves. Finally, a Cox statistical model was established to estimate the impact of the observable factors.

Results: We found 37,217 newly identified CRC patients between 2008 and 2019 in Chile, corresponding to 103,239 hospital discharges. In the same period, 24,217 people died of CRC. A nearly linear, steady increase in crude incidence, mortality and prevalence was observed. CRC incidence was the lowest in the North of the country, increasing toward the South and reaching a maximum value of 34.6/100,000 inhabitants/year in terms of crude incidence and 20.7/100,000 inhabitants/year in terms of crude mortality in the XII region in 2018. We found that older patients had lower survival rates, as well as men compared to women. Survival was significantly better for patients with private insurance than those under the public insurance system, and the treating hospital also played a significant role in the survival of patients. Patients in the capital region survived longer than those in almost every other part of the country. We found no significant effect on survival associated with the GES program.

Conclusions: We found important inequalities in the survival probabilities for CRC patients in Chile. Survival depends mainly on the type of insurance, access to more complex hospitals, and geographical location; all three factors correlated with socioeconomic status of the population. Our work emphasized the need to create specific programs addressing primary causes to decrease the differences in CRC survival.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Construction of treatment and death databases–inclusion and exclusion criteria.
Source: DEIS patient discharge database 2001–2019, DEIS mortality database 2000–2018.
Fig 2
Fig 2. Prevalence rate and crude and age-standardized incidence and mortality rates (cases/100,000 p.).
Fig 3
Fig 3. Five-year Kaplan–Meier survival curve for all patients, with 95% confidence interval.
Fig 4
Fig 4. Five-year Kaplan–Meier survival curves by health care insurance, with 95% confidence intervals.
Fig 5
Fig 5. Five-year Kaplan–Meier survival curves by type of hospital, with 95% confidence intervals.
Fig 6
Fig 6. Five-year Kaplan–Meier survival curves by insurance, for patients getting treatment in the same subset of hospitals, with 95% confidence intervals.
Fig 7
Fig 7. Cox proportional hazards regression model.
Base: FONASA B, GES period, Female, Colon tumor, High complexity 1 public hospital, in the XIII Metropolitan region.
See this image and copyright information in PMC

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