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Outcomes Among Patients With Colon Cancer Living in Neighborhoods With Persistent Poverty.

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Patients with colon cancer living in persistent poverty (PP) face higher mortality risks. Guideline-concordant care may mediate this association, highlighting areas for policy intervention.

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Area of Science:

  • Oncology
  • Public Health
  • Health Services Research

Background:

  • Persistent poverty (PP) is linked to poorer cancer outcomes.
  • Existing interventions may not address unique mechanisms of PP.
  • Identifying modifiable targets is crucial for policy development.

Purpose of the Study:

  • To compare colon cancer clinical outcomes based on the proportion of census tracts in PP at diagnosis.
  • To explore potential mechanisms, including access and quality of care, linking PP to disease-specific mortality.

Main Methods:

  • Retrospective cohort study of 20,015 colon cancer patients in California (2017-2020).
  • Exposure defined by the proportion of census tracts per zip code in PP.
  • Fine-Gray competing risk survival models used to assess mortality and mediation by care access/quality.

Main Results:

  • Higher PP ratios were associated with increased disease-specific mortality (HRs 1.20-1.19).
  • Patients in higher PP areas were younger, more often Hispanic or Black, and had higher comorbidity.
  • Guideline-concordant care receipt potentially mediated the association between PP and mortality.

Conclusions:

  • Living in persistent poverty is associated with higher colon cancer mortality.
  • The findings underscore the need for targeted interventions within persistent poverty areas.
  • Further research can inform policies to improve cancer care equity for vulnerable populations.