Early-Onset Colorectal Cancer Survival by Race and Ethnicity in a Large Community-Based Insured Population

Abstract

Background and Aims

Colorectal cancer (CRC) incidence in those under age 50 is increasing and minority populations are known to have worse CRC survival outcomes. Therefore, we evaluated 5-year CRC-specific survival by race and ethnicity among medically insured patients with early-onset CRC.

Methods

This retrospective cohort study included Kaiser Permanente Northern California patients aged 18–49 years diagnosed with CRC between 2006 and 2019. Five-year CRC-specific survival by race and ethnicity was assessed using Kaplan-Meier survival analyses and unadjusted and adjusted Cox proportional hazards models.

Results

Among 1620 patients, 50.3% were White, 21.6% Hispanic, 20.1% Asian or Pacific Islander, and 8.0% Black. Stage IV disease was found in 23.4% of White, 28.7% of Black, 30.1% of Asian or Pacific Islander, and 31.1% of Hispanic patients. Five-year CRC-specific survival probability estimates ranged from 74.4% in Hispanic patients to 79.9% in White patients with no statistically significant differences in unadjusted risk estimates. However, after adjusting for age, sex, comorbidities, and socioeconomic status measures, risk of death was higher in Hispanic vs White patients (hazard ratio: 1.46; 95% confidence interval: 1.08–1.97) but was attenuated (hazard ratio: 1.13; 95% confidence interval: 0.83–1.53) after further adjustment for stage at diagnosis.

Conclusion

Among medically insured patients in a large integrated healthcare setting, Hispanic patients were more likely to be diagnosed with stage IV CRC and had the lowest 5-year CRC-specific survival probability compared to other race groups. Additional research is needed to identify factors contributing to the higher rate of late-stage disease diagnosis in Hispanic patients.