Sociodemographic factors may influence survival among young adults with colorectal cancer
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Young adults with colorectal cancer who resided in areas with the lowest incomes and high school graduation rates had a 24% increased risk for death than their counterparts in areas with the highest incomes and graduation rates, according to study results scheduled for presentation at Gastrointestinal Cancers Symposium.
Further, among these patients, those who resided in urban areas had a 10% higher risk for death than those who resided in metropolitan areas, regardless of income level.
“There are a lot of disparities in health care. It is important to look at the sociodemographic disparities so that we can learn more and try to eliminate them,” Ashley Matusz-Fisher, MD, researcher in the department of internal medicine at Levine Cancer Institute at Atrium Health, said in a press release.
Incidence of colorectal cancer among young adults has been increasing, with rates among those aged younger than 50 years up 51% since 1994. However, the impact of sociodemographic status on this patient population is not well-known.
Matusz-Fisher and colleagues pooled data from the National Cancer Database on 26,768 adults aged 40 years and younger (51.6% men; 78.7% white) diagnosed with colorectal cancer between 2004 and 2016.
Researchers grouped patients according to income and education levels of the areas in which they lived.
About one-third of the patients (32.3%) resided in areas with median income of $68,000 or higher (highest income areas), whereas 18.4% resided in areas with median income of $38,000 or lower (lowest income areas). About 32% resided in metropolitan areas, compared with 18.4% who resided in urban areas.
Twenty-three percent of patients resided in areas with the highest high school graduation rates (93% or higher) and 20% resided in areas with the lowest high school graduation rates (less than 79%).
Patients who resided in the lowest vs. highest income and education areas appeared more likely to be black (OR = 6.4; 95% CI, 5.6-7.4), lack private insurance (OR = 6.3; 95% CI, 5.6-7), have T3 stage or T4 stage disease (OR = 1.4; 95% CI, 1.3-1.6), have positive nodes (OR = 1.2; 95% CI, 1.1-1.3), be readmitted to the hospital within 30 days (OR = 1.3; 95% CI, 1.1-1.6), and have a Charlson-Deyo comorbidity score of 1 or higher (OR = 1.6; 95% CI, 1.4-1.9). They also appeared less likely to undergo surgery (OR = 0.63; 95% CI, 0.6-0.7).
After the researchers adjusted for race, insurance status, T and N stage, and Charlson-Deyo comorbidity score, they found that patients who resided in the lowest vs. highest income and education areas had a 24% increased risk for death (adjusted HR = 1.24; 95% CI, 1.1-1.44). In addition, they observed a 10% increased risk for death (adjusted HR = 1.1; 95% CI, 1.01-1.2) among those residing in urban vs. metropolitan areas.
Patients with stage IV disease who resided in the lowest income areas had shorter median OS than those residing in the highest income areas (1.72 years vs. 2.17 years; P < .001).
“Young adults with colorectal cancer in the lowest income and education populations were more likely to have worse OS,” the researchers wrote. “Furthermore, regardless of income, patients in metropolitan areas seemed to have a lower risk for death, likely due to greater access to care. More efforts are needed to eliminate disparities and achieve health equity.” – by Jennifer Southall
Reference:
Matusz-Fisher A, et al. Abstract 13. Presented at: Gastrointestinal Cancers Symposium; Jan. 23-25, 2020; San Francisco.
Disclosure: Matusz-Fisher reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
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Christopher Lieu, MD
Incidence of colorectal cancer in the younger — and unscreened — population is increasing in the United States and other countries. The etiology of this increase is unknown, although this is an area of active investigation given the concerning rise in diagnoses. Young patients have unique challenges associated with interruptions in education, career and family planning, as well as a need for special focus on preserving fertility, financial hardships and peer-support groups.
In the current study, Matusz-Fisher and colleagues investigated sociodemographic disparities among young adults with colorectal cancer and correlated them with outcomes such as OS. Young adults from the lowest income and education areas had a 24% increased risk for death compared with those from the highest income and education areas.
This study adds to the overall understanding of early-onset colorectal cancer, which is a new and evolving field of research. The results highlight the importance of socioeconomic factors on OS, and the need for intervention to determine why OS is reduced in this population. Further study will help identify areas of improvement to eliminate disparities, which can lead to improved health equity.
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