BACKGROUND
Neighborhood socioeconomic context influences access to colorectal cancer (CRC) care and outcomes, yet its independent contribution to short-term surgical outcomes remains unclear. This study evaluated associations between neighborhood level Yost socioeconomic status (SES) and urgent presentation and short-term outcomes among older adults undergoing CRC surgery.
METHODS
Medicare beneficiaries aged 66-90 years who underwent colectomy or rectal resection for malignant CRC were identified from SEER-Medicare data (2006-2019). Census tract-level Yost SES quintiles were linked to patient records. Multivariable regression models assessed associations between SES and urgent presentation, index complications, and 90-day mortality, adjusting for demographic, clinical, and hospital characteristics. Sensitivity analyses using the Social Vulnerability Index were performed.
RESULTS
Among 72,491 patients (77.4% colon; 22.6% rectal), lower neighborhood SES was associated with more acute presentation and worse short-term outcomes. Emergency diagnosis occurred more frequently in the lowest versus highest SES quintile (16.7% vs 11.6%), and 90-day mortality was higher (11.0% vs 7.5%). In adjusted analyses, higher SES was consistently protective, with lower odds of urgent presentation (Q5 vs Q1: OR 0.71; 95% CI 0.67-0.76), index complications (OR 0.81; 95% CI 0.75-0.88), and 90-day mortality (OR 0.74; 95% CI 0.66-0.83). Urgent presentation strongly predicted complications (OR 2.35; 95% CI 2.24-2.46) and mortality (OR 4.88; 95% CI 4.58-5.21).
CONCLUSIONS
Lower neighborhood SES is independently associated with higher likelihood of urgent CRC presentation, postoperative complications, and early mortality. Incorporating neighborhood socioeconomic context into CRC care delivery, risk adjustment, and equity-focused policy frameworks may improve outcomes for disadvantaged populations.
E. Worku, S. Woldesenbet, T. Pawlik· Journal of Gastrointestinal...· 0 citations
OBJECTIVE
To assess how diagnostic pathways affect clinical outcomes and healthcare costs among older adults diagnosed with colorectal cancer (CRC).
SUMMARY OF BACKGROUND DATA
Many CRC cases in the United State are diagnosed during an emergency presentation, which have been linked to worse outcomes. Understanding how diagnostic routes may impact a cancer diagnosis may be critical for improving care.
METHODS
We analyzed SEER-Medicare data (2005-2019) for patients aged ≥ 65 years with CRC. Diagnostic routes were classified as screening, inpatient/outpatient (IP/OP), or emergency presentation (ER) based on encounters within 30-day to 6-months before diagnosis. Multivariable regression evaluated associations between route and outcomes.
RESULTS
Among 79,251 CRC patients (colon: 72.4%, rectum: 27.6%), diagnoses occurred via ER (13.7%), IP/OP (60.6%), and screening (25.7%). Compared with screened patients, ER-diagnosed patients were older (median age: 79 vs. 75), had higher comorbidity (22.5% vs. 8.1%), and lower income (29.1% vs. 23.9%). ER diagnosis was associated with urgent surgery (59.7% vs. 20.1%), complications (29.8% vs. 14.2%), extended stay (37.2% vs. 14%), inpatient mortality (7.4% vs. 2.1%), lower discharge to home (32.2% vs. 62.4%), and higher 90-day mortality (16.8% vs. 5%). Multivariable analysis confirmed ER diagnosis as the strongest predictor of stage IV disease (OR 1.75, 95% CI: 1.66-1.84), urgent surgery (OR 5.14, 95%CI: 4.83-5.48), and 90-day mortality (OR 1.80, 95%CI: 1.62-1.99; all p < 0.001). Costs were higher for ER versus screening: index surgery ($13,802 vs. $11,458) and postoperative care ($9,470 vs. $3,655).
CONCLUSIONS
Emergency CRC diagnosis was associated with worse outcomes and higher costs, emphasizing the need for targeted screening and earlier detection strategies.
E. Worku, S. Woldesenbet, Odysseas P. Chatzipanagiotou et al.· Journal of Surgical Oncology· 0 citations
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