Mortality rate and predictors of colorectal cancer patients in Ethiopia: a systematic review and meta-analysis.

ABSTRACT

INTRODUCTION: The incidence of colorectal cancer (CRC) has been increasing in Sub-Saharan countries, including Ethiopia. However, the real mortality rate for CRC patients in Ethiopia has not been established. Therefore, this systematic review and meta-analysis aimed to determine the overall mortality rate and identify predictors among CRC patients in Ethiopia. METHODS: PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar were searched to identify relevant articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. The quality of the included studies was assessed using the Newcastle-Ottawa Scale Critical Appraisal checklist. A random effect model was used to estimate the pooled mortality rate and adjusted hazard ratio (AHR). Publication bias was assessed using funnel plots and Egger's regression test, while heterogeneity was evaluated through the Cochran Q test and I2 statistics. RESULTS: After reviewing 74 articles, only 7 studies met the criteria and were included in the analysis. The analysis revealed that the overall mortality rate among CRC patients in Ethiopia was 40.5% (95% confidence interval [CI] 32.05, 48.87) while the survival rates at 1 year, 3 years, and 5 years were 82.3% (95% CI 73.33, 91.31), 48.8% (95% CI 43.35, 54.32), and 26.6% (95% CI 21.26, 31.91) respectively. Subgroup analysis indicated that studies conducted after 2017 had higher mortality rates compared to those studied earlier (43.0% vs. 38.2%). Older age (AHR 1.89, 95% CI 1.27, 2.82); being married (AHR 2.53, 95% CI 1.79, 3.57); having comorbidities (AHR 1.84, 95% CI 1.45, 2.35); having high CEA levels (AHR 2.06, CI 1.35, 3.13); being in stage II (AHR 4.13, 95% CI 1.85, 9.22), III (AHR 8.62, 95% CI 3.88, 19.15), and IV (AHR 8.06, CI 2.89, 22.49) were the most important predictors. CONCLUSION: In Ethiopia, the mortality rate among individuals diagnosed with CRC is high, with two out of five patients dying from this disease. Age, marital status, CEA level, comorbidities, and cancer stage were identified as predictors of mortality in CRC patients. Therefore, early detection and screening should be prioritized, particularly for older patients, those who are married, have comorbidities, elevated CEA levels, and advanced cancer stages.