Racial/Ethnic Disparities in Early-Onset Colorectal Cancer Outcomes

Although some researchers have examined EO-CRC clinical presentations, much of this research has focused on non-US populations or single healthcare centers. Limited research has also explored outcomes across diverse racial/ethnic groups. Thus, we examined the relationship of five racial/ethnic groups (non-Hispanic White [NHW], non-Hispanic Black [NHB], American Indian/Alaskan Native [AI/AN], Asian/Pacific Islanders [PI], Hispanic) with EO-CRC tumor characteristics/histologic types and risk of CRC death.

We conducted a retrospective cohort analysis using data from the 2006-2020 Surveillance, Epidemiology, and End Results Program. Multivariable Cox proportional hazards regression and logistical regression models were performed.

Among 46,956 patients, the lower 5-year survival rate was 64.8% among NHB patients (vs. 69.7% for AI/AN, 70.6% for Hispanic, 72.4% for Asian/PI, and 73.4% for NHW patients, p-value < 0.001). In multivariable analysis, NHB, Asian/PI, and Hispanic patients were 10-12% more likely to have late stage at diagnosis and had increased risk of CRC death by 9-37% than NHW patients (p-value < 0.05). Further, NHB patients were 52% more likely to have a right-sided CRC (OR, 1.52; 95% CI, 1.43-1.61), Asian/PI were 15% more likely to have high pathological grading (OR, 1.15; 95% CI, 1.06-1.25), and Hispanic patients were 25% more likely to have MAC/SC subtype (OR, 1.25; 95% CI, 1.16-1.35).

Effective patient-centered communication tailored to the specific needs of racial and ethnic minorities through primary care initiatives may have potential for improving early detection and outcomes, particularly for younger populations and racial minorities.