SAN FRANCISCO-Young adults with colorectal cancer (CRC) who live in low-income and low-education areas, or urban areas, have worse overall survival and a higher risk of death, according to a new retrospective analysis of more than 26,000 young adults age 40 and under. Each year, more than 16,000 people under age 50 are diagnosed with CRC in the U.S., and incidence rates among this population have risen 51 percent since 1994, with the sharpest increase among those ages 20-29.
"There are a lot of disparities in health care," said lead author, Ashley Matusz-Fisher, MD, of the Levine Cancer Institute, Charlotte, N.C. "It is important to look at the sociodemographic disparities so that we can learn more and try to eliminate them."
Matusz-Fisher presented the results of the study at the 2020 ASCO Gastrointestinal Cancers Symposium (Abstract 13).
About the Study
Previous studies have explored sociodemographic disparities in patients with cancer, including those with CRC. According to the authors, this study is the first one to explore sociodemographic disparities in young adults with CRC and to study whether residential location correlates with outcomes such as overall survival.
The researchers used data from the National Cancer Database of 26,768 young adults who were diagnosed with colorectal cancer between 2004 and 2016. About half of the patients were male (51.6%) and half were female (48.4%). The majority of patients were white (78.7%); others were black (14.6%) and of other races (6.6%).
Researchers categorized patients based on whether they lived in areas of low or high income as well as educational level. About one-third of patients resided in the highest income areas ($68,000 or greater median income) and 18.4 percent lived in areas with the lowest income ($38,000 or lower median income). About a quarter of patients lived in areas with the highest high school graduation rates (at least 93% of students graduated) and 20 percent lived in areas with the lowest rates (less than 79% of high school students graduated). In addition, about one-third of patients lived in metropolitan areas and 18.4 percent lived in urban areas.
Key Findings
Young adult patients from the lowest income and lowest education areas had a 24 percent increased risk of death compared with those from the highest income and highest education areas. In addition, after researchers adjusted for race, insurance status, tumor and node stage of cancer, and comorbidities, they found that patients from urban areas had a 10 percent increased risk of death compared with those from metropolitan areas, regardless of income.
Patients diagnosed with stage IV cancer in the lowest income areas also had worse median overall survival as compared with those residing in higher income areas.
In addition, researchers found that patients in the lowest income areas were more likely to be black, not have private health insurance, have T3/T4 stage disease, have positive nodes, be re-hospitalized within 30 days, have a Charlson-Deyo score >= 1, and were less likely to have surgery.
In conclusion, Matusz-Fisher said: "Young adults with CRC in the lowest income and education population were more likely to have worse overall survival. Furthermore, regardless of income, patients in metropolitan areas seemed to have a lower risk of death likely due to greater access to care."
Next Steps
"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," said the senior author, Mohamed E. Salem, MD, gastrointestinal oncologist and Associate Professor of Medicine at Levine Cancer Institute, Charlotte, N.C. "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."
Richard L. Schilsky, MD, ASCO Chief Medical Officer and Executive Vice President, commented: "We have recently seen a concerning trend that CRC incidence in young adults is on the rise. Coupled with the findings from this study, which show how CRC outcomes in young adults are impacted by where they live, it is clear this issue needs greater attention. Every patient with cancer should have access to the highest quality cancer care, no matter where they live."
Mark L. Fuerst is a contributing writer.