Young Adults with CRC in Low Income and Education Populations More Likely to Have Worse OS

January 23, 2020

Given the data presented in this abstract, researchers indicated that it is crucial that further research works toward eliminating these disparities.

Young adults with colorectal cancer (CRC) in the lowest income and education population were more likely to have worse overall survival, according to a study published in the Journal of Clinical Oncology.1

The researchers also indicated that regardless of income, patients in metropolitan areas seemed to have a lower risk of death presumably to due to greater access to care. These findings will be presented at the 2020 Gastrointestinal Cancers Symposium, taking place January 23-25, in San Francisco, California. 

“There are a lot of disparities in health care,” lead author Ashley Matusz-Fisher, MD, from Levine Cancer Institute, said in a press release.2 “It is important to look at the sociodemographic disparities so that we can learn more and try to eliminate them.” 

In this retrospective analysis, 26,768 young adults (≤40 years of age) diagnosed with CRC between 2004 and 2016 were studied using the National Cancer Database. Males made up 51.6% of the patients, and 78.7% were white, 14.6% black, and 6.6% of other races. In total, 32.3% of the participants resided in the highest income areas (median ≥$68,000), compared to 18.4% who lived in the lowest (< $38,000). 

Twenty-three percent of the patients lived in areas that had the highest high school graduation rate (> 93%), whereas 20% lived in areas of the lowest graduation rate (< 79%). Additionally, 32.3% of participants came from metropolitan areas, while 18.4% came from urban areas. Patients in the lowest compared to the highest income and education areas were more likely to be black (OR: 6.4, 5.6-7.4), not have private insurance (OR: 6.3, 5.6-7.0), have T3/T4 stage (OR: 1.4, 1.3-1.6), have positive nodes (OR: 1.2, 1.1-1.3), be hospitalized again within 30 days (OR: 1.3, 1.1-1.6), or have a Charlson-Deyo score ≥ 1 (OR: 1.6, 1.4-1.9), and were also less likely to have surgery (OR: 0.63, 0.6-0.7). 

After making adjustments for race, insurance status, T/N stage, and Charlson-Deyo comorbidity scores, participants from the lowest vs highest income and education areas had a 24% increased risk of death (HRadj:1.24, CI 1.1-1.44, P = 0.004). Patients from urban vs metropolitan areas saw a 10% increased risk of death (HRadj: 1.10, CI 1.01-1.20, = 0.02). Those with stage IV disease in the lowest vs highest income populations had worse median overall survival (1.72 vs. 2.17 years, < 0.001). 

The researchers indicated that, given the data presented, further efforts are necessary to eliminate disparities and bring about health equity. 

“Disparities do not necessarily translate to racial or ethnic differences; many other types of disparity exist among our patients that affect the availability of and access to cancer care, and likely will influence patient outcomes,” senior author Mohamed E. Salem, MD, gastrointestinal oncologist and associate professor of medicine at Levine Cancer Institute, said in a press release. “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.” 

Studies have previously investigated sociodemographic disparities in patients with cancer, including those with CRC. However, according to the researchers, this study is the first to delve into sociodemographic disparities specifically in young adults with CRC and to study whether residential location corresponds with outcomes like overall survival. 

According to the American Society of Clinical Oncology, more than 16,000 people each year under age 50 are diagnosed with colorectal cancer in the US. Moreover, incidence rates among this population have risen 51% since 1994, with the most severe increase among those age 20 to age 29. 

References:

1. Matusz-Fisher A, Trufan SJ, Kadakia KC, et al. Sociodemographic disparities in young adults with colorectacl cancer (CRC): Analysis of 26,768 patients in the National Cancer Database (NCDB). J Clin Oncol 38, 2020 (suppl 4; abstr 13). 

2. Young Adults with Colorectal Cancer in Low-Income and Low-Education Areas, or Urban Areas, Have Worse Overall Survival and a Higher Risk of Death [news release]. Alexandria, Virginia. Published January 21, 2020. asco.org/about-asco/press-center/news-releases/young-adults-colorectal-cancer-low-income-and-low-education. Accessed January 23, 2020.