OBJECTIVES:

This study aims to determine if disparities in early diagnosis, treatment, and survival outcomes existed between urban vs. rural, as well as between US-Mexico border vs. non-border areas among early-onset colorectal cancer (EO-CRC) patients in Texas.

METHODS:

This cross-sectional study used 2011-2019 Texas Cancer Registry limited use data. Patients aged 18-49 years diagnosed with colorectal cancer classified as in-situ, localized, or regional stage were included. Age at diagnosis, time between diagnosis to treatment, optimal treatment receipt, and overall and 5-year survival were compared between patients living in border vs. non-border areas, and urban vs. rural areas stratified by stage. Other covariates included age, gender, race/ethnicity, insurance status, poverty index, and comorbidities. Bivariate and multivariable regression analyses were used.

RESULTS:

Among patients diagnosed with EO-CRC between 2011-2019 in Texas (N=8099), 624 (7.7%) lived in a border area, and 855 (10.6%) resided in a rural area. Among all patients, mean age at diagnosis was 41.6 (SD=6.9) years. Among patients in regional stage, those from rural areas (50.2%) were less likely to be diagnosed at age younger than 45 (OR=0.76, 95% CI 0.62-0.92, p=0.0046) compared to those from urban areas (56.7%). There was no significant difference in diagnosis to treatment time between border vs. non-border or urban vs. rural areas. Overall, 76.1% of the patients received optimal treatment. However, compared to non-border areas, a lower proportion from border areas received optimal treatment (76.4% vs. 72.6%, p=0.0367). The 5-year survival rates were significantly lower for in-situ/localized patients in border areas compared to non-border areas [84.9% (SE=2.7%) vs. and 89.7% (SE=0.6%), p=0.0418].

CONCLUSIONS:

This study found that early diagnosis disparities existed between urban vs. rural areas, and optimal treatment and survival outcomes disparities existed between border vs. non-border areas. These outcomes may be important when considering diagnosis and treatment for patients in Texas with EO-CRC.