| Summary: | Background: Colorectal cancer (CRC) ranks as the second most deadly cancer globally, accounting for nearly 10 % of all cancer-related deaths in 2021. Despite advancements in CRC management, significant disparities in survival rates persist, even in highly developed countries. These lower survival rates are particularly evident in socioeconomically deprived areas and regions with limited healthcare accessibility. Our objective was to assess the impact of individual and geographical variations on CRC survival outcomes. Methods: This retrospective cohort study utilised secondary data from the National Cancer Registry. Adult CRC patients diagnosed between 1st January 2013 to 31st December 2018 (6 years), with documented cause of deaths were included. Kaplan-Meier survival analysis was conducted to determine the 5-year survival rate and median survival time, while multilevel Cox proportional hazard analysis was carried out to identify factors that contribute to the overall CRC survival. Results: A total of 18,513 CRC patients were diagnosed between 2013 and 2018, with 10,819 deaths occurred during follow-up. The 5-year CRC survival rate was 42 % with median survival time of 36 months (95 %CI: 34.46–37.54). After adjusting for covariates in multilevel Cox proportional hazard regression analysis, the study found that older age, male gender, Malay and other ethnicities, living in Peninsular Malaysia, rectal, rectosigmoid and anal cancers, advanced disease stage, receiving other, none or delayed treatments, and living in less densely populated areas were significantly associated with a higher risk of mortality (p < 0.05). Conclusion: This study identified several sociodemographic, clinical and population density factors that can influence CRC survivals in Malaysia. These findings provide valuable insights for policymakers to focus on high-risk populations with poor survival, in providing cancer control services and enhancing existing cancer prevention programmes to improve survival outcomes. © 2025 Elsevier Ltd
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