Higher Early-Onset CRC Mortality Seen in Minorities

TOPLINE:
Death rates for patients aged < 50 years with early-onset colorectal cancer (EOCRC) are higher in native Hawaiian and other Pacific Islander individuals and non-Hispanic Black individuals than in non-Hispanic White individuals (adjusted hazard ratios [aHRs], 1.34 and 1.18, respectively). The largest racial and ethnic disparities in survival were linked to neighborhood socioeconomic status.
METHODOLOGY:
US rates of EOCRC are increasing, with differences across racial and ethnic groups, but few studies have provided detailed risk estimates in the categories of Asian American and of Native Hawaiian or other Pacific Islander, as well as the contribution of sociodemographic factors to these differences.
A population-based cohort study analyzed California Cancer Registry data for 22,834 individuals aged 18-49 years diagnosed with EOCRC between January 2000 and December 2019.
Researchers examined the association between mortality risk and racial and ethnic groups, including Asian American (15.5%, separated into seven subcategories), Hispanic (30.2%), Native Hawaiian or Other Pacific Islander (0.6%), non-Hispanic American Indian or Alaska Native (0.5%), non-Hispanic Black (7.3%), and non-Hispanic White (45.9%) individuals, with a median follow-up of 4.2 years.
Statistical models measured baseline associations adjusting for clinical features and then tested for the contribution of socioeconomic factors together and separately, with adjustments for insurance status, neighborhood socioeconomic status, and more.
TAKEAWAY:
Native Hawaiian or Other Pacific Islander individuals demonstrated the highest EOCRC mortality risk compared with non-Hispanic White individuals (socioeconomically [SES] aHR, 1.34; 95% CI, 1.01-1.76).
Non-Hispanic Black individuals showed a higher EOCRC mortality risk than non-Hispanic White individuals (SES aHR, 1.18; 95% CI, 1.07-1.29).
Hispanic individuals’ higher EOCRC mortality (base AHR, 1.15; 95% CI, 1.08-1.22) disappeared after adjusting for neighborhood socioeconomic status (SES aHR, 0.98; 95% CI, 0.92-1.04).
Southeast Asian individuals’ increased mortality risk (base AHR, 1.17; 95% CI, 1.03-1.34) was no longer significant after adjusting for insurance status (SES aHR, 1.10; 95% CI, 0.96-1.26).
IN PRACTICE:
“As clinicians and researchers, we should ask ourselves how to act on these findings,” wrote authors of an invited commentary. “The effort cannot stop with data analysis alone, it must extend to actionable steps,” such as tailored efforts to deliver culturally competent care and patient navigation services to those with greatest need and at highest risk, they added.
SOURCE:
The study was led by Joshua Demb, PhD, University of California San Diego in La Jolla, California. The study was published online on November 22 in JAMA Network Open with the invited commentary led by Claire E. Jacobson, MD, University of Michigan, Ann Arbor, Michigan.
LIMITATIONS:
The study was limited by a relatively short follow-up time and low sample sizes in some racial and ethnic groups, potentially leading to imprecise adjusted hazard ratio estimates. The generalizability of findings beyond California requires further investigation, and the ability to examine potential associations between neighborhood socioeconomic status and other factors was also constrained by small sample sizes.
DISCLOSURES:
The study received support from the National Cancer Institute at the National Institutes of Health. One study author reported receiving consulting fees from Guardant Health Inc, InterVenn Biosciences, Geneoscopy, and Universal DX; research support from Freenome; and stock options from CellMax LLC outside the submitted work. No other disclosures were reported by other authors of the study or the commentary.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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