Geographic Disparities in EAO-CRC Survival Among Men Linked to High Levels of Poverty

A recent study published by the American Journal of Cancer Research examined the impact of geographic disparities on the survival of men with early-age onse­­­­t colorectal cancer (EAO-CRC). The goal of the study was to identify gender-specific differences among those with EAO-CRC, while examining individual and county-level factors.

Data from the Centers for Disease Control and Prevention (CDC) and the Surveillance, Epidemiology, and End Results (SEER) were analyzed to study CRC patterns among men aged 15 to 49 years who were diagnosed between 1999 and 2017. EAO-CRC deaths were classified as deaths among US residents aged 15-54 from 1999-2017. Men aged 50-54 were included to account for patients diagnosed at age 49 with standardized 5-year follow-ups. In identifying hotspots, researchers at the CDC used the International Classification of Diseases, Tenth Revision (ICD-10) codes to identify county-level EAO-CRC frequencies,crude rates, and age-adjusted rates. U.S. counties were then classified as hotspots if they had high rates of EAO-CRC mortality as determined by geospatial analyses. The study population included Hispanic men and non-Hispanic white and black men. . Chi-square test helped determine variances in patient- and county-level characteristics between men in hotspot counties and in non-hotspot counties. Survival was estimated based on the date of diagnosis and the date of the last follow-up appointment or death.

The study identified 232 counties as EAO-CRC hotspots— a majority were located in the South, at a vast 92% or 214 of the 232 hotspot counties. The remaining 8%, or 18 of the 232 counties, were located in the Midwest. Although the average age of men diagnosed with EAO-CRC was 42.73 years, age was not a significant differential among men in the individual hotspot counties.

Men living in hotspot areas were more likely to be:

• Non-Hispanic black
• Less likely to be Hispanic
• Less likely to be married or have a domestic partner

Men residing in these areas were also more likely to be diagnosed with metastatic CRC than men living in other areas.

Hotspot counties commonly shared the following characteristics compared to other counties:

• Higher poverty rates
• Higher rates of adult obesity
• More physical inactivity along
• Fewer exercise opportunities
• Limited access to healthy foods
• Lower college completion rates
• Higher adult smoking rates
• Higher uninsured rates
• Fewer primary care physicians
• Increased rurality
• More violent crimes

Overall, men residing in these hotspot areas had a lower CRC survival rate than those in non-hotspot counties. Specifically, men diagnosed with EAO-CRC who lived in hotspots had a 24% increased risk of CRC-specific death than those in non-hotspot areas. Smoking was identified as a major cause of EAO-CRC mortality in hotspots, as EAO-CRC patients in these areas who smoked had a 12% higher rate of mortality than men who did not.

Implications

CRC hotspots in the U.S. tended to be associated with risk factors related to high levels of poverty. Potential explanations for these hotspots could be inadequate access to health care, a knowledge gap on CRC risks and symptoms, and high uninsured rates. The results of the study emphasize the need for increased education on symptoms, preventative measures, and treatments of CRC, especially in hotspot areas.

The article says: Study participants were NH-White, NH-Black, and Hispanic adults or adolescents aged 15-49 at primary CRC diagnosis. A total of 32,447 men in the SEER database were diagnosed with EOCRC from 1999-2016,