OBJECTIVES: Colorectal cancer (CRC) is the third most common form of cancer in men and women in West Virginia. Hospitalization followed by surgical resection is the standard curative treatment. The aim of this study is to examine colorectal cancer hospitalizations and common comorbidities and evaluate associated outcomes during 2003-2007 in West Virginia. METHODS: Data from the Healthcare Cost and Utilization Project (HCUP), State Inpatient Database were investigated. Comorbidities were identified using comorbidity software provided by HCUP. Descriptive statistics for hospitalizations with a primary or secondary diagnosis of CRC were tabulated. Multivariate regressions were used to compare for differences in the outcomes including length of stay, total charges, and in-hospital deaths. RESULTS: There were 6919 admissions with a primary or secondary diagnosis of CRC of which 27.4% were emergency admissions. The most common comorbidity was diabetes (18.5%), followed by COPD and hypertension (both 3.7%). Volume depletion disorder (3.5%) followed by pneumonia (2.4%) and malignant neoplasm of the liver (2.3%) were the most common primary diagnoses seen when CRC was the secondary diagnosis. Mean length of stay was significantly higher for admissions with a primary diagnosis (9.2 days versus 4.8 days, p<0.001). Mean total charges were also higher for primary diagnosis (28,618.94 USD versus 12,195.22 USD, p<0.001). For the 356 (5.1%) in-hospital deaths, emergency admissions had odds ratio (OR) of 2.50 (95% CI, 2.01-3.10), and primary diagnosis of CRC had OR of 1.64 (95% CI, 1.30-2.08). Admissions with comorbid diabetes formed 12.6% (45) of patients who died in the hospital. CONCLUSIONS: Significant resources are consumed by CRC hospital admissions. A large percentage of CRC hospitalizations are emergency admissions indicating advanced disease and possibly failure of timely screening. Diabetes was the most common comorbid condition and further investigation in diabetics is needed to check screening behavior and access to screening centers.