Low Income, Education Areas Lead to Higher Mortality Risk in Young Adult Patients with Colorectal Cancer


The study was the first to explore sociodemographic disparities in young adult patients with colorectal cancer.

Patients with colorectal cancer who live in areas with lower income (less than $38,000) and lower education (under 79% high school graduation rate), as well as those who live in urban areas, had worse outcomes and a higher mortality risk, according to a retrospective analysis presented at the 2020 Gastrointestinal Cancers Symposium conference in San Francisco, California.

The study was the first to explore sociodemographic disparities in young adult patients with colorectal cancer and to study whether residential location correlates with outcomes such as overall survival (OS).

Researchers categorized patients based on whether they lived in areas of low or high income and education. Approximately 32% of patients resided in the highest income areas ($68,000 or greater median income) and 18.4% lived in areas with the lowest income ($38,000 or lower median income).

Twenty-three percent of patients lived in areas with the highest high school graduation rates (93%) and 20% lived in areas with the lowest rates (less than 79%). In addition, approximately 32% lived in metropolitan areas and 18.4% lived in urban areas.

Young adult patients from the lowest income and education areas had a 24% higher mortality risk compared with patients from the highest income and education areas. After adjusting for race, insurance status, stage of cancer, and comorbidities, the study authors found that patients from urban areas had a 10% increased risk of death compared with patients from metropolitan areas, regardless of income.

Patients diagnosed with stage 4 cancer in the lowest income areas also had worse median OS compared with individuals residing in higher income areas. Lastly, the study authors found that patients in the lowest income areas were more likely to be black, not have private health insurance, have more comorbidities, and present with more advanced cancer.

Each year approximately 16,000 individuals aged 50 years or younger are diagnosed with colorectal cancer in the United States. Incidence rates in this patient population have risen 51% since 1994, with the sharpest increase among individuals aged 20 to 29 years.

“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 Mohamed E. Salem, MD, gastrointestinal oncologist and associate professor of Medicine at Levine Cancer Institute in a press release. “Although awareness of health care disparities has increased, considerable knowledge gaps still exist, particularly among young adult [patients] 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.”


  • 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 [press release]. ASCO website. Published January 21, 2020. https://www.asco.org/about-asco/press-center/news-releases/young-adults-colorectal-cancer-low-income-and-low-education. Accessed January 24, 2020.

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