A large cohort study published in JAMA Network Open has documented significant disparities in survival among young adults with metastatic colorectal cancer (mCRC) based on neighbourhood-level socioeconomic status (SES) and, to a lesser extent, race and ethnicity. The findings underscore the influence of structural determinants on outcomes in a population increasingly diagnosed with advanced colorectal malignancy.
Using a comprehensive electronic health record-derived database of patients treated across more than 280 community oncology clinics in the United States between 2013 and 2021, researchers investigated all-cause mortality and survival at one, two, and three years from diagnosis among adults aged 18 to 49 years with de novo or recurrent metastatic disease.
Overall, survival varied across racial and ethnic groups, with lower three-year survival observed among Black patients (approximately 41 %) compared with White, Asian, and Hispanic cohorts. However, after adjustment for sociodemographic factors, tumour characteristics,s and treatment variables, the increased mortality risk associated with Black race was not statistically significant.
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In contrast, neighbourhood-level socioeconomic status was strongly associated with outcomes. Individuals residing in the lowest SES quintile had significantly worse survival than those in the highest quintile, with a 51 % higher adjusted risk of mortality. Survival estimates at three years were approximately 41 % in the lowest SES quintile versus nearly 59 % in the highest SES quintile, indicating a pronounced gradient by socioeconomic context.
The cohort included more than 3,100 young adults with metastatic disease, with detailed stratification by race, ethnici, ty and SES. Neighbourhood SES was defined using census-derived composite metrics, capturing multiple domains of economic and social conditions. This allowed for an examination of ‘place-based’ disparities that extend beyond individual clinical factors.
The authors highlight that, although the incidence of mCRC among young adults has risen over recent years, disparities in survival persist and are shaped by broader structural factors. They propose that interventions to improve outcomes should extend beyond clinical care to address the social and economic contexts in which patients live, including access to care, resources for early detection, and tailored support across the care continuum.
These findings contribute to the growing body of evidence linking socioeconomic disadvantage with poorer cancer outcomes, and support ongoing efforts to integrate equity-oriented strategies into oncology practice and health policy. Future research will be needed to clarify mechanisms driving these disparities and to evaluate targeted interventions.
Paper: Wang JSJohnson BMurphy CC. Racial, Ethnic, and Socioeconomic Survival Disparities in Early-Onset Metastatic Colorectal Cancer. JAMA Netw Open. 2026;9(1):e2553146. doi:10.1001/jamanetworkopen.2025.53146. Access online here.
