Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia

Abstract Background: Significantly higher colorectal cancer (CRC) mortality exists in the five public health districts of Georgia including the Clayton, West Central, East Central, Southeast, and Northeast Georgia. Particularly, CRC outcomes are poorer among patients living in low socioeconomic (SES) areas with predominantly Black population in Georgia. We sought to examine 5-year CRC survival rates between White and Black/Other patients and determine whether regional SES status associated with 5-year CRC survival within different race groups in these five regions of Georgia. Methods: We performed a retrospective cohort analysis using data from the 1975-2016 Surveillance, Epidemiology, and End Results program. The 2015 United State Department of Agriculture Economic Research Services (USDA ERS) county typology codes were used to identify region-level SES with persistent poverty, low employment, and low education. A county is classified by the USDA ERS as a persistent poverty by using 1980, 1990, 2000 censuses and 2007-11 American Community Survey. Five-year CRC survival rates were compared by using Kaplan-Meier method. Cox proportional hazard regression was used to examine the aforementioned associations in different race groups adjusted for demographics (gender, age at diagnosis, marital status, and five Georgia regions) and tumor features (stage, grade, and primary site). Results: Among 11,023 CRC patients (31.9% Black/Other patients), 5-year CRC survival rates were lower among Black/Other patients compared to White patients (65.9% vs. 69.9%; p-value<0.001). Black/Other patients living in low education, low employment, and persistent poverty regions appeared to have lower 5-year survival rates compared to those not living in those regions (59.6% vs. 67.8%, p-value<0.001; 65.4% vs. 66.2%, p-value=0.385; 64.4% vs. 66.5%, p-value=0.089 respectively). In the adjusted analysis, we found that White patients living in regions with persistent poverty were 1.12-fold of increased risk of CRC death (HR, 1.12; 95% CI, 1.00-1.25; p-value=0.043) compared to those living in non-persistent poverty regions. Among Black/Other patients, those living in regions with low education were 1.19-fold of increased risk of CRC death (HR, 1.19; 95% CI, 1.01-1.40; p-value=0.033) compared to those living in non-low education regions. Other factors, such as older age at diagnosis, distant stage, and high-grade tumors, were positively associated with CRC death among the entire cohort, regardless of racial groups. Conclusion: In Georgia, we found that Black/Other patients demonstrated the lower CRC survival rates. Region-level SES was associated with CRC survival among White and Black/Other patients. White patients living in regions with persistent poverty, and Black/Other patients living in regions with low education had an increased risk of CRC death. Our findings provide important evidence to relevant stakeholders in furthering the development of culturally tailored CRC screening interventions aimed at CRC early detection by considering patient’s regional SES status in Georgia. Citation Format: Meng-Han Tsai, Shaoyong Su, Marlo Vernon, Yanbin Dong. Racial disparities in the relationship of regional socioeconomic status and colorectal cancer survival in the five regions of Georgia [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A100.