Impact of social determinants of health on women with early-onset colorectal cancer: A retrospective study.

Abstract

3662 Background: The incidence of early-onset colorectal cancer (EOCRC) in adults under age 50 has significantly increased. Women with EOCRC often present with nonspecific gastrointestinal symptoms, leading to delayed diagnosis and care. The impact of social determinants of health (SDOH), such as insurance status, income, and race, on cancer outcomes, disease presentation and hospitalization severity in young women with EOCRC is not well known. This study investigates how SDOH factors are associated with stage at presentation, emergency admission, metastatic burden and inpatient outcomes in women hospitalized with EOCRC. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2018-2021) with hospitalized women aged 18–49 years, diagnosed with colorectal cancer, identified using ICD-10. SDOH variables included primary payer (private, Medicare, Medicaid, uninsured), ZIP-code median income, race, age and year of hospitalization. Primary outcomes included advanced stage at presentation, emergency admission, visceral metastatic involvement, disseminated metastasis, inpatient mortality, discharge disposition and length of stay (LOS). Survey-weighted multivariable logistic regression and linear regression models were performed, adjusting for age, race, insurance status and income quartile. Results: The most consistent predictors of delayed presentation and increased hospitalization severity were insurance status and race. Compared to private insurance, women with Medicare and Medicaid were 67% and 32% more likely to present with advanced stage (p<0.001), and over 3-fold and 2.5-fold more likely to present emergently (p<0.001). They were also significantly more likely to have visceral metastasis (p<0.001), have increased severity of illness (p≤0.023), require non-home discharge (p<0.001), and require longer LOS (+0.8-0.9 days, p<0.001). Medicare was associated with higher inpatient mortality (p=0.005). Black race was independently associated with advanced stage, emergency presentation, visceral metastasis, inpatient mortality (all p<0.001), and longer LOS (+0.79 days, p<0.001). Younger age was associated with advanced stage and visceral metastasis (p<0.001). Higher ZIP-code income quartiles were associated with lower odds of emergency presentation (p<0.001), but not improved inpatient outcomes. Year of diagnosis was not significant across models. Conclusions: Among young women hospitalized with colorectal cancer, insurance status and race were strongly associated with advanced disease, emergency presentation, metastatic burden and greater hospitalization severity, independent of ZIP-code income. These disparities did not show improvement over time, highlighting system-level barriers. Targeted strategies to improve access and earlier recognition in high-risk populations of young women is required to improve oncologic outcomes.