Low Socioeconomic Status is not a Predictor of Worse Colorectal Cancer Survival

Purpose: Colorectal Cancer (CRC) is the third most common cancer in the UK. Factors with well-established relation to CRC survival include age, tumor site and stage. Socioeconomic Status (SES) is a factor that may play a role in survival but current evidence on this is conflicted. We aim to investigate the effect of SES on CRC survival.

Methods: This is a retrospective cohort analysis of all patients diagnosed with CRC in South Tees NHS Trust between January 2006-January 2019. Demographics were collected from a trust database. SES was defined using the Index of Multiple Deprivation (IMD). Cox- regression was used to investigate the effect of different factors on overall survival and Kaplan-Meier analysis to estimate survival.

Results: A total of 5,060 patients diagnosed with CRC, with a median follow-up of 60 months, were included. Overall survival was 77.2%, 59.6% and 50.3% at 1-year, 3-years and 5-years, respectively. Colon cancer was associated with worse survival than rectal cancer (p=0.003, hazard ratio=1.163). On multivariate analysis, socioeconomic deprivation was not associated with poorer CRC outcomes (hazard ratio=1.022, p=0.523).

Conclusion: There is a lack of uniformity in the reported effect of SES on CRC survival across different studies. This could be due to the heterogeneity of healthcare systems globally or a lack of uniform parameters used to assess SES. In this study, SES did not impact CRC survival. We therefore suggest that effective diagnosis and treatment, made available to all at the point of delivery, might mitigate any differences in survival across socioeconomic groups.

Author(s): Farah Mahmoud Ali, Natalie Hamer, Oladiran Olatunbode, Trisha Jha, Prem Thambi, Nicholas Wadd, Dharmendra Garg and Madan Jha

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