Cummins Kaelyn C, El Moheb Mohamad, Shen Chengli, Kim Susan J, Witt Russell, Ruff Samantha M, Tsung Allan
Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA.
Cancers (Basel). 2025 Apr 22;17(9):1399. doi: 10.3390/cancers17091399.
Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as a proxy for low individual SES, experience better outcomes when residing in high-SES neighborhoods.
Using the National Cancer Database, we examined Medicaid CRC patients, stratifying them by neighborhood SES indicators: median household income and education level. Patients in the highest and lowest quartiles of income and education were compared. Medicaid patients from the highest-SES neighborhoods were compared to the general population. Multivariable regression models analyzed 30- and 90-day postoperative mortality, overall survival (OS), and time from diagnosis to treatment initiation and surgery.
CRC patients in high-income neighborhoods began treatment earlier (coefficient -1.847, = 0.015) and exhibited improved OS (HR 0.810, < 0.001) compared to those in low-income neighborhoods, irrespective of education level. Similarly, patients in high-education neighborhoods started treatment sooner (coefficient -3.926, < 0.001) and had better OS (HR 0.897, < 0.001). No differences were observed in time to surgery or postoperative mortality. Despite these advantages, Medicaid patients in high-income (HR 1.130, < 0.001) and high-education (HR 1.209, = 0.002) areas still had worse OS compared to non-Medicaid patients.
Higher neighborhood SES is associated with a significant survival benefit for Medicaid CRC patients, but these patients still lag behind their non-Medicaid counterparts. Understanding the mechanisms by which neighborhood SES influences cancer outcomes could inform targeted interventions to close the survival gap.
社会经济地位（SES）对结直肠癌（CRC）患者的预后有显著影响，来自低社会经济背景的患者预后较差。然而，生活在富裕社区可能通过环境优势减轻其中一些差异。本研究调查了作为低个体社会经济地位代表的医疗补助保险CRC患者，居住在高社会经济地位社区时是否有更好的预后。
利用国家癌症数据库，我们对医疗补助CRC患者进行了检查，并根据社区SES指标（家庭收入中位数和教育水平）对他们进行分层。比较了收入和教育水平处于最高和最低四分位数的患者。将来自最高社会经济地位社区的医疗补助患者与普通人群进行比较。多变量回归模型分析了术后30天和90天死亡率、总生存期（OS）以及从诊断到开始治疗和手术的时间。
与低收入社区的患者相比，高收入社区的CRC患者开始治疗更早（系数 -1.847，P = 0.015），且总生存期有所改善（风险比0.810，P < 0.001），与教育水平无关。同样，高教育水平社区的患者开始治疗更早（系数 -3.926，P < 0.001），总生存期更好（风险比0.897，P < 0.001）。手术时间或术后死亡率未观察到差异。尽管有这些优势，但与非医疗补助患者相比，高收入（风险比1.130，P < 0.001）和高教育水平（风险比1.209，P = 0.002）地区的医疗补助患者总生存期仍然较差。
较高的社区SES与医疗补助CRC患者显著的生存获益相关，但这些患者仍落后于非医疗补助患者。了解社区SES影响癌症预后的机制可为缩小生存差距的针对性干预措施提供依据。
