Disparities in the diagnosis and treatment of gastric cancer in relation to disabilities

Introduction: We investigated potential disparities in the diagnosis, treatment, and survival of gastric cancer (GC) patients with and without disabilities. Methods: Welinked 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. Results: Whencompared to GC patients without disabilities, patients with disabilities tendedto be diagnosedat 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 thosewithout disabilities (29.3% vs 27.2%, P<0.001), and this disparitywas 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] 5 1.18, 95% confidence interval: 1.14-1.21 and aHR 5 1.12, 95% confidence interval: 1.09-1.16, respectively), and these disparities were more pronounced in those with severe disabilities (aHR 5 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.