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Abstract

Background: Area of residence may adversely affect survival and outcomes in many cancers. Our study evaluates impact of geographical and demographic disparities on survival in patients with colorectal cancer. Materials and Methods: Data was obtained from the NCDB colon, rectosigmoid, and rectal datasets. Patients were categorized by area of residence: metropolitan (MA), urban (UA), or rural (RA). Sociodemographic and tumor-related data was collected and analyzed to evaluate variables affecting overall survival (OS). Results: 973,139 patients, spanning 2004-2013 were included in the study, 83% MA, 15% UA, 2% RA. RA and UA pts were mostly white male with lower income and no comorbidities. On univariate analysis, OS among all patients with colorectal cancer was worse for RA (HR 1.10) and UA (1.06) patients, as compared to MA. On multivariate analysis, difference persisted with worse OS for RA (HR 1.02, p = .04) and UA (HR 1.01, p = .003). Black (HR 1.14) and native American (HR 1.17) patients had worse outcomes, while Asians (HR 0.8), women (HR 0.88) and patients with higher income had improved OS (HR 0.88). Conclusion: The difference in OS for RA and UA patients with colorectal cancer remained significantly driven by economic disparity. It represents an important factor independently limiting access to care, particularly in geographically isolated individuals.

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