EP779 - Persistent Poverty is Associated with Delays in Colorectal Cancer Diagnosis and an Increased Risk of Requiring Urgent Cancer Surgery

Image or Table (Do Not add text here):

Purpose/Background: Areas of persistent poverty (PP) experience both a higher incidence of colorectal cancer (CRC) and a higher cancer mortality. In 2023, the Biden-Harris Administration launched the Persistent Poverty Initiative to combat the effects of PP on cancer outcomes by exposing the structural and institutional drivers of health inequity and supporting community-based interventions aimed at closing gaps in care. In this study, we explored delayed diagnosis and delayed receipt of diagnostic services as potential mechanisms linking PP and worse cancer outcomes.

Methods/Interventions: We identified all patients diagnosed with CRC in California between 2017 and 2020 using the California Cancer Registry. We then overlayed data from the U.S. Census, which defines PP as Census tracts in which at least 20% population has lived below the Federal Poverty Line for at least 30 years. Patients were grouped based on the percentage of Census tracts in their home ZIP code meeting the definition of PP (0%, 1-25%, 26-50%, or >50%). We used multivariable regression to compare the likelihood of having definitive cancer surgery and of requiring urgent surgery based on patients’ level of PP exposure. Among patients who presented to the Emergency Department (ED) in the year prior to their diagnosis, we also compared the time and number of CRC-related ED visits that occurred prior to receiving their cancer diagnosis.

Results/Outcomes: 25,163 patients were included in the analysis. The majority of patients lived in areas with no PP at the time of their CRC diagnosis (66.5%). On univariate analysis, patients living in areas with PP were younger, more likely to utilize Medicaid, and more likely to identify as a racially minoritized group. Increasing levels of PP were associated with a stepwise increase in Stage IV disease at diagnosis and a stepwise decrease in Stage I disease; there were no differences in Stage II or III disease. After adjusting for clinical and sociodemographic variables, patients living in areas with higher levels of PP were more likely to require urgent surgery (odds ratio [OR] 1.09-1.37 by level of PP, p< 0.001). In addition, patients exposed to PP had more CRC-related ED visits and waited a longer time between their initial ED presentation and their eventual cancer diagnosis (Table).

Conclusion/Discussion: Exposure to PP is associated with later stage at diagnosis, an increase likelihood of requiring urgent surgery, and a longer time period between initial evaluation and diagnosis among patients with CRC. Our results suggest that delays in diagnosis--even among patients symptomatic enough to present to the ED--represent an important pathway linking exposure to PP and worse cancer outcomes. Although further work is required to understand why patients living in PP experience these delays, interventions aimed at improving access to both screening and diagnostic services in these communities will be essential to improving survival and cancer-related health equity.