Socioeconomic disparities in survival of patients with superficial colorectal cancer
TL;DR
A critical intersectional pattern in which marital status and income were jointly correlated with inferior survival outcomes was identified, with older age, male gender, Black race, unmarried status, and lower income associated with poorer outcomes.
Abstract
Limited data are available regarding the impact of socioeconomic disparities on the survival of patients with superficial colorectal cancer (SCRC). We used population-based data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program registry to conduct a retrospective cohort study to examine the impact of gender, race, geographic location, and socioeconomic factors on survival outcomes in SCRC patients. Additionally, we explored how socioeconomic factors influenced survival in SCRC patients when stratified by age at diagnosis. To assess the influence of socioeconomic factors on overall survival (OS) and cancer-specific survival (CSS), we employed the Cox proportional hazards model, adjusting for relevant clinical characteristics. 50,671 SCRC patients were included in the final analysis. Compared to patients aged 20–39, older age groups showed progressively higher hazards of CSS, with adjusted hazard ratios (AHR) of 1.21 (95%CI 0.85–1.72) for the 40–49 age group, 1.45 (95%CI 1.05-2.00) for the 50–59 age group, 1.97 (95%CI 1.43–2.70) for the 60–69 age group, and 4.25 (95%CI 3.11–5.82) for those aged 70 or older. Statistically significant increases in CSS hazard were observed in the 50–59, 60–69 and 70 years or older age groups. The AHR for OS among patients aged 40–49, 50–59, 60–69, and 70 or older was 1.54 (95%CI 1.18–2.01), 2.24 (95%CI 1.75–2.86), 4.07 (95%CI 3.20–5.18), and 10.98 (95%CI 8.65–13.94), respectively. Female patients had higher 5-year CSS (by 0.80% points) and OS (by 2.50% points) rates compared to male patients. Black patients showed comparable CSS to White patients. However, their OS was significantly lower (AHR = 1.08, 95% CI 1.02–1.14), corresponding to a 1.70-percentage-point reduction in the 5-year OS rate. Furthermore, among patients aged 50–59, the hazard of death was elevated for those who were unmarried (AHR = 1.90, 95% CI 1.68–2.15) or had low income (AHR = 2.27, 95% CI: 1.62–3.18) alone, but it was markedly higher for those possessing both risk factors (AHR = 3.63, 95% CI 2.17–6.10). Rural residents also demonstrated a survival advantage, particularly in the 40–49 age group. This study found significant socioeconomic disparities in SCRC survival, with older age, male gender, Black race, unmarried status, and lower income associated with poorer outcomes. Moreover, we identified a critical intersectional pattern in which marital status and income were jointly correlated with inferior survival outcomes. Potential strategies including expanded screening coverage, optimized medical care accessibility and culturally adapted health policies are proposed as future research directions, which may help alleviate clinical disparities and facilitate health equity in SCRC management.