The impact of socioeconomic status on survival in stage III colon cancer patients: A retrospective cohort study using the SEER census‐tract dataset

Abstract

Background The impact of socioeconomic status (SES) has been described for screening and accessing treatment for colon cancer. However, little is known about the “downstream” effect in patients who receive guideline‐concordant treatment. This study assessed the impact of SES on cancer‐specific survival (CSS) and overall survival (OS) for stage III colon cancer patients. Methods The SEER Census Tract‐Level SES Dataset from 2004 to 2015 was used to identify stage III colon adenocarcinoma patients who received curative‐intent surgery and adjuvant chemotherapy. The predictor variable was census tract SES. SES was analyzed as quintiles. The outcome variables were OR and CSS. Statistical analysis included chi square tests for association, Kaplan–Meier, Cox, Fine and Gray regression for survival analysis. Results In total, 27,222 patients met inclusion criteria. Lower SES was associated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, higher T stage, and lower grade tumors. CSS at the 25th percentile was 54 months for the lowest SES quintile and 80 for the highest. Median OS was 113 months for the lowest SES quintile and not reached for highest. The 5‐year CSS rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest ( p < 0.001). The 5‐year OS rate was 66.5% for the lowest SES quintile and 74.6% in the highest ( p < 0.001). Conclusion This is the first study to evaluate CSS and OS in an incidence‐based cohort of stage III colon cancer patients using a granular, standardized measure of SES. Despite receipt of guideline‐based treatment, SES was associated with disparities in CSS and OS.

Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

“…3 Further, we found that Black patients living in low-education (59.4% vs. 67.3%) regions appeared to have lower 5-year survival rates compared to those not living in low-education regions. Compared with findings from other studies, the 5-year survival rate was 72.4% for the lowest SES quintile compared to 78.9% in the highest SES quintile for CRC patients, 23 which is in line with our findings. Associations between neighborhood disadvantage and higher CRC stage at diagnosis and mortality have been found in other studies.…”

Young-Onset Gastrointestinal Adenocarcinoma Incidence and Survival Trends in the Northern Territory, Australia, with Emphasis on Indigenous Peoples

“…The impact of colonisation globally continues to impact the socioeconomic and health status and life expectancy for Indigenous populations as compared to non-Indigenous populations. Social determinants and lower socioeconomic status have been consistently associated with poor cancer survival [ 44 , 45 ]. In 2006, Anderson et al [ 46 ] alarmingly reported that the life expectancy of Aboriginal and Torres Strait Islander peoples was 20 years lower than that for the total Australian population.…”

Impact of socioeconomic status on cancer staging, survival in non-small cell lung cancer

“…Hastertet al ( 13 ) demonstrated that people living in the lowest socioeconomic status areas had higher colorectal cancer incidence compared to living in the highest socioeconomic status areas. Another study ( 14 ) showed that lower SES was correlated with younger age, Black or Hispanic race/ethnicity, Medicaid/uninsured, and higher T stage. Our results also showed that NSCLC patients with lower SES were associated with young adults, black race, male, squamous carcinoma, upper lobe site and advanced stage.…”