据报道，在高度脆弱的社区中，癌症结果存在差异。本研究的目的是评估结直肠癌患者的社会脆弱性与接受指南一致护理 (GCC) 和死亡风险之间的关系。这项回顾性观察研究确定了 I-III 期结肠癌或 II-III 期直肠癌患者来自国家癌症登记数据库计划 2018 年至 2020 年的癌症。数据与县级疾病预防控制中心社会脆弱性指数（SVI）合并。 GCC 被定义为适合分期的淋巴结切除术、放射治疗或全身治疗。多变量逻辑回归和 Cox 比例风险回归研究了 SVI（分层为四分位数的连续和分类变量）分别与 GCC 和 3 年癌症特异性死亡风险的关联。 在 124,950 名患者中（结肠癌，n=102,399；直肠癌，n） =22,551），中位 SVI 为 60.9（IQR 35.0 至 79.5）。 SVI 最高四分位数的患者接受 GCC 的几率降低了 21%（95% CI 0.76 - 0.83）。在癌症委员会 (CoC) 认可的医院进行的治疗与 GCC 增加相关（OR 1.79；95% CI 1.72 - 1.85）。尽管 SVI 与 GCC 概率之间存在负相关且递减的关联，但未经 CoC 认证的医院的概率下降速度快于 CoC 认证的医院 (p<0.05)。根据 GCC 的接受情况进行调整后，在 CoC 认可的医院接受治疗的高度脆弱患者的死亡风险降低（HR 0.91；95% CI 0.83 - 0.98）。对于高度脆弱的患者，在 CoC 认可的医院接受治疗与 GCC 的接受增加相关死亡率风险降低，这可能反映了 CoC 认证对遵守治疗指南、社区参与和解决护理障碍的要求。版权所有 © 2024 美国外科医生学会。由 Wolters Kluwer Health, Inc. 出版。保留所有权利。

Cancer outcome disparities have been reported in highly vulnerable communities. The objective of this study was to evaluate the association of social vulnerability with receipt of guideline-concordant care (GCC) and mortality risk for patients with colorectal cancer.This retrospective observational study identified patients with stage I-III colon or stage II-III rectal cancer between 2018 and 2020 from the National Program of Cancer Registries Database. Data were merged with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI) at the county level. GCC was defined as stage-appropriate lymphadenectomy, radiation therapy, or systemic therapy. Multivariable logistic regression and Cox proportional hazards regression investigated associations of SVI, as a continuous and categorical variable stratified into quartiles, with GCC and 3-year cancer-specific mortality risk, respectively.Among 124,950 patients (colon, n=102,399; rectal, n=22,551), median SVI was 60.9 (IQR 35.0 to 79.5). Patients in the highest SVI quartile had 21% decreased odds of receiving GCC (95% CI 0.76 - 0.83). Treatment at Commission on Cancer (CoC) accredited hospitals was associated with increased GCC (OR 1.79; 95% CI 1.72 - 1.85). Although there was an inverse, decreasing association between SVI and probability of GCC, probability at non-CoC-accredited hospitals declined faster than at CoC-accredited hospitals (p<0.05). After adjusting for receipt of GCC, highly vulnerable patients treated at CoC-accredited hospitals had decreased mortality risk (HR 0.91; 95% CI 0.83 - 0.98).For highly vulnerable patients, treatment at CoC-accredited hospitals was associated with increased receipt of GCC and decreased mortality risk, which may reflect CoC-accreditation requirements for treatment guideline adherence, community engagement, and addressing barriers to care.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.