Evaluation of disparities in colorectal cancer outcomes with increasing age: A national population-based study

Accelerated biological aging has been reported in certain racial/ethnic groups, raising concerns about widening outcome disparities with age. This phenomenon has not been adequately explored in cancer outcomes.

National Cancer Database (2010-2021) was used to analyze outcomes in colorectal cancer (CRC) patients by race/ethnicity and age at diagnosis: < 65, 65-69, 70-74, 75-79, and ≥ 80 years. Primary outcomes were overall survival (OS) and 90-day postoperative mortality (PM), analyzed with multivariable regression.

In this large national cohort study of 585,729 patients, non-Hispanic Black (nHB) patients had worse OS across all age groups, with the largest disparity in the < 65 group (median OS: 64.1 in nHB vs. 127.0 months in non-Hispanic White (nHW); HR 1.28, 95% CI 1.26-1.30) and smaller disparity in ≥ 80 group (median OS: 19.2 in nHB vs. 26.5 months in nHW; HR 1.06, 95% CI 1.03-1.09). The 90-day PM in nHB patients was higher than nHW, particularly in the < 65 (OR 1.23, 95% CI 1.15-1.31) group.

In contrast to non-oncological literature, we did not observe widening racial/ethnic disparities with age. Largest disparities were found in younger age groups suggesting differences in tumor biology may play a more important factor for cancer outcomes.