Neighborhood Socioeconomic Status Tied to Survival in US Early-Onset Metastatic Colorectal Cancer
Key Clinical Summary
- In a cohort of 3115 adults aged 18 to 49 years with metastatic colorectal cancer (mCRC) treated at 280 US community-based clinics, 3-year survival differed by race/ethnicity and neighborhood-level socioeconomic status (SES).
- Three-year survival was lowest among Black patients (40.7%) and patients living in the lowest SES quintile (40.6%).
- After adjustment, neighborhood SES remained significantly associated with mortality (HR, 1.51 for lowest vs highest SES quintile), while the elevated risk for Black patients was not statistically significant.
Survival disparities in early-onset metastatic colorectal cancer are understudied despite rising incidence in young adults. In a cohort study published in JAMA Network Open, investigators used a large electronic health record–derived database from US community oncology clinics to examine whether race/ethnicity and neighborhood-level SES are associated with mortality in adults aged 18 to 49 years with de novo or recurrent mCRC.
Study Findings
The study analyzed 3115 young adults with mCRC treated at 280 community-based US clinics from 2013 to 2021 and followed through December 31, 2022. Mean age at diagnosis was 42.4 years; 53.0% were male. The cohort included 13.6% Black patients, 12.7% Hispanic patients, 3.9% Asian patients, and 60.2% White patients.
Neighborhood-level SES was derived from census block group data using the Yost Index, incorporating American Community Survey estimates (2015-2019). Survival differed significantly by both race/ethnicity and SES. At 3 years, survival was 40.7% (95% CI, 35.7%-45.6%) among Black patients versus 46.9% (95% CI, 44.5%-49.3%) among White patients; Asian and Hispanic patients had higher 3-year survival (57.5% and 53.3%, respectively). By SES, 3-year survival was 40.6% (95% CI, 36.1%-45.1%) in the lowest quintile versus 58.9% (95% CI, 54.1%-63.4%) in the highest.
In adjusted Cox models, the lowest vs highest neighborhood SES quintile was associated with higher mortality (HR, 1.51; 95% CI, 1.24-1.82). The adjusted hazard ratio for Black race vs White race was 1.08 (95% CI, 0.90-1.31).
Clinical Implications
For oncology clinicians treating young adults with mCRC, the findings reinforce that structural conditions linked to neighborhood disadvantage are associated with survival even after accounting for tumor and treatment characteristics. The authors note that neighborhood-level SES may reflect unequal access to resources needed for high-quality care and healthy behaviors, with downstream effects such as transportation barriers, reduced access to academic practices, and limited availability of clinical trial sites.
While unadjusted survival was lowest among Black patients, the lack of statistical significance after adjustment suggests that measured clinical and sociodemographic factors may partially explain observed differences. However, the authors emphasize that inequities may still be shaped by upstream drivers, including structural inequities affecting living environments and health care utilization.
The study also highlights potential gaps in trial participation: clinical trial enrollment was lower among Hispanic and Asian patients compared with White patients. The authors suggest multilevel interventions—policy, health system, and community clinic strategies—may be needed to address survival disparities.
Conclusion
The investigators conclude that “structural conditions, such as neighborhood-level SES, impact survival among young adults with mCRC.” They report that, although Black patients had lower 3-year survival, “only the association between neighborhood-level SES and survival remained statistically significant after adjusting for covariates,” underscoring the role of place-based disadvantage in outcomes.
Reference
Wang JS, Johnson B, Murphy CC. Racial, ethnic, and socioeconomic survival disparities in early-onset metastatic colorectal cancer. JAMA Netw Open. 2026;9(1):e2553146. doi:10.1001/jamanetworkopen.2025.53146
