Background: Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as a proxy for low individual SES, experience better outcomes when residing in high-SES neighborhoods. Methods: Using the National Cancer Database, we examined Medicaid CRC patients, stratifying them by neighborhood SES indicators: median household income and education level. Patients in the highest and lowest quartiles of income and education were compared. Medicaid patients from the highest-SES neighborhoods were compared to the general population. Multivariable regression models analyzed 30- and 90-day postoperative mortality, overall survival (OS), and time from diagnosis to treatment initiation and surgery. Results: CRC patients in high-income neighborhoods began treatment earlier (coefficient −1.847,p= 0.015) and exhibited improved OS (HR 0.810,p< 0.001) compared to those in low-income neighborhoods, irrespective of education level. Similarly, patients in high-education neighborhoods started treatment sooner (coefficient −3.926,p< 0.001) and had better OS (HR 0.897,p< 0.001). No differences were observed in time to surgery or postoperative mortality. Despite these advantages, Medicaid patients in high-income (HR 1.130,p< 0.001) and high-education (HR 1.209,p= 0.002) areas still had worse OS compared to non-Medicaid patients. Conclusions: Higher neighborhood SES is associated with a significant survival benefit for Medicaid CRC patients, but these patients still lag behind their non-Medicaid counterparts. Understanding the mechanisms by which neighborhood SES influences cancer outcomes could inform targeted interventions to close the survival gap.
背景：社会经济地位（SES）显著影响结直肠癌（CRC）患者的预后，低SES背景的患者往往面临更差的结局。然而，居住在富裕社区可能通过环境优势缓解部分差异。本研究探讨了以医疗补助（Medicaid）参保作为低个体SES代理指标的CRC患者，若居住在高SES社区，是否可获得更好的预后。方法：利用美国国家癌症数据库，我们分析了医疗补助CRC患者，并根据社区SES指标（家庭收入中位数和教育水平）进行分层。比较了收入与教育水平最高和最低四分位数的患者。将来自最高SES社区的医疗补助患者与普通人群进行比较。采用多变量回归模型分析术后30天和90天死亡率、总生存期（OS），以及从诊断到开始治疗和手术的时间。结果：与低收入社区患者相比，高收入社区的CRC患者无论教育水平如何，均更早开始治疗（系数−1.847，p=0.015）且OS更优（HR 0.810，p<0.001）。同样，高教育水平社区的患者治疗启动更早（系数−3.926，p<0.001），OS也更好（HR 0.897，p<0.001）。在手术等待时间或术后死亡率方面未观察到差异。尽管存在这些优势，与未参保医疗补助的患者相比，高收入（HR 1.130，p<0.001）和高教育水平（HR 1.209，p=0.002）社区的医疗补助患者OS仍较差。结论：较高的社区SES为医疗补助CRC患者带来显著的生存获益，但这些患者仍落后于非医疗补助参保者。理解社区SES影响癌症结局的机制，可为制定针对性干预措施以缩小生存差距提供依据。
肿瘤(癌症)患者之家