A retrospective analysis of 26,768 young adults with colorectal cancer aged 40 and under found that those who live in areas with lower income (a median income of less than $38,000) and less education (under 79% high school graduation rate), as well as those who live in urban areas, had worse outcomes and a higher risk of death. The results will be presented by Matusz-Fisher et al at the 2020 Gastrointestinal (GI) Cancers Symposium (Abstract 13).

Each year, more than 16,000 people under age 50 are diagnosed with colorectal cancer in the United States, and incidence rates among this population have risen 51% since 1994, with the sharpest increase among those aged 20 to 29, according to data published by Siegel et al in the Journal of the National Cancer Institute.

“There are a lot of disparities in health care,” said lead author Ashley Matusz-Fisher, MD, of the Levine Cancer Institute in Charlotte, North Carolina. “It is important to look at sociodemographic disparities so that we can learn more and try to eliminate them.”

Methods

Previous studies have explored sociodemographic disparities in patients with cancer, including those with colorectal cancer; however, according to the authors, this study is the first to explore sociodemographic disparities in young adults with colorectal cancer and to study whether residential location correlates with outcomes such as overall survival.

Researchers analyzed data from the National Cancer Database on 26,768 young adults who were diagnosed with colorectal cancer between 2004 and 2016. Male patients comprised 51.6% of the cohort. The majority of patients were white (78.7%); 14.6% were black, and 6.6% were of other races.

Researchers categorized patients based on whether they lived in areas of low or high income and education. About 32% of patients resided in the highest income areas (median income = ≥ $68,000) and 18.4% lived in areas with the lowest income (median income = < $38,000). About a quarter of patients (23%) lived in areas with the highest high school graduation rates (> 93%), and 20% lived in areas with the lowest rates (< 79%). About 32% lived in metropolitan areas, and 18.4% lived in urban areas.

Key Findings

Young adult patients from the lowest income and education areas had a 24% increased risk of death compared with those from the highest income and education areas. After adjusting for race, insurance status, stage of cancer, and comorbidities, patients from urban areas had a 10% increased risk of death compared with those from metropolitan areas, regardless of income.

Patients diagnosed with stage IV cancer in the lowest income areas had a worse median overall survival, compared with those residing in higher-income areas. Researchers also found that patients in the lowest income areas were more likely to be black, to not have private health insurance, to have more comorbidities, and to present with more advanced cancer.

Next Steps

“Disparities do not necessarily translate to racial or ethnic differences; many other types of disparit[ies] exist among our patients that affect the availability of and access to cancer care, and likely will influence patient outcomes,” said senior study author Mohamed E. Salem, MD, a gastrointestinal oncologist and Associate Professor of Medicine at Levine Cancer Institute. “Although awareness of health-care disparities has increased, considerable knowledge gaps still exist, particularly among young adults with cancer. Therefore, more effort to increase awareness regarding health-care disparities is warranted to provide access and remove barriers to care so that we can eliminate disparities and achieve health equity.”

Disclosure: For full disclosures of the study authors, visit coi.asco.org.