Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma-A SEER Registry Analysis

Mark M Aloysius; Hemant Goyal; Niraj J Shah; Kumar Pallav; Nimy John; Mahesh Gajendran; Abhilash Perisetti; Benjamin Tharian

doi:10.3390/cancers13133262

Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma-A SEER Registry Analysis

Cancers (Basel). 2021 Jun 29;13(13):3262. doi: 10.3390/cancers13133262.

Authors

Mark M Aloysius¹, Hemant Goyal¹, Niraj J Shah², Kumar Pallav³, Nimy John⁴, Mahesh Gajendran⁵, Abhilash Perisetti⁴, Benjamin Tharian⁴

Affiliations

¹ Department of Internal Medicine, The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA 18505, USA.
² Division of Digestive Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
³ Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, USA.
⁴ Department of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA.
⁵ Department of Internal Medicine, Texas Tech University Health Science Center El Paso, 2000B Transmountain Road, El Paso, TX 79911, USA.

Abstract

Introduction: We aimed to assess the impact of socio-economic determinants of health (SEDH) on survival disparities within and between the ethnic groups of young-onset (<50 years age) colorectal adenocarcinoma patients.

Patients and methods: Surveillance, epidemiology, and end results (SEER) registry was used to identify colorectal adenocarcinoma patients aged between 25-49 years from 2012 and 2016. Survival analysis was performed using the Kaplan-Meir method. Cox proportional hazards model was used to determine the hazard effect of SEDH. American community survey (ACS) data 2012-2016 were used to analyze the impact of high school education, immigration status, poverty, household income, employment, marital status, and insurance type.

Results: A total of 17,145 young-onset colorectal adenocarcinoma patients were studied. Hispanic (H) = 2874, Non-Hispanic American Indian/Alaskan Native (NHAIAN) = 164, Non-Hispanic Asian Pacific Islander (NHAPI) = 1676, Non-Hispanic black (NHB) = 2305, Non-Hispanic white (NHW) = 10,126. Overall cancer-specific survival was, at 5 years, 69 m. NHB (65.58 m) and NHAIAN (65.67 m) experienced worse survival compared with NHW (70.11 m), NHAPI (68.7), and H (68.31). High school education conferred improved cancer-specific survival significantly with NHAPI, NHB, and NHW but not with H and NHAIAN. Poverty lowered and high school education improved cancer-specific survival (CSS) in NHB, NHW, and NHAPI. Unemployment was associated with lowered CSS in H and NAPI. Lower income below the median negatively impacted survival among H, NHAPI NHB, and NHW. Recent immigration within the last 12 months lowered CSS survival in NHW. Commercial health insurance compared with government insurance conferred improved CSS in all groups.

Conclusions: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors conferring favorable survival found on multivariate analysis.

Keywords: colon cancer; colorectal cancer; poverty; race; socioeconomic determinants of health; survival.