Background: Socioeconomic disadvantage is widely associated with poor clinical outcomes among patients with colorectal cancer. Interventions to address these pervasive public health problems have had mixed success, potentially related to their development based on aggregated data (e.g., average zip code income) and short-term outcomes, rather than individual level data and meaningful long-term cancer outcomes.

Objective: To examine associations of individual and cumulative multiple, co-occurring individual-level social risk factors with long-term cancer-specific survival among patients with advanced colorectal cancer.

Design: Prospective cohort study.

Setting: Between 2011-2014, we collaborated with Surveillance, Epidemiology and End Result in Georgia and Detroit to survey patients with Stage III colorectal cancer in the prior year. Cumulative social risk was calculated by summing significant factors associated with colorectal cancer-specific mortality: employment, insurance, health literacy, income, and marital status.

Patients: Patients with stage III colorectal cancer.

Main outcome measures: Time from diagnosis to cancer-specific mortality, adjusted for age, race, sex, and chemotherapy receipt, with comparisons provided in hazard ratios with 95% confidence intervals.

Results: Among 1173 patients, pre-operative unemployment (1.76 [1.30-2.39]), uninsured or Medicaid insurance (1.54 [1.12-2.11]), low health literacy (1.40 [1.00-1.95]), annual income < $50,000 (1.34 [1.01-1.77]) and being unpartnered (1.34 [1.02-1.77]) were associated with higher likelihood of cancer-specific mortality. In cumulative risk analyses, each added social risk was associated with 24% higher adjusted likelihood of cancer-specific mortality (1.24 [1.12-1.37]).

Limitations: This study has limitations inherent to survey research including the potential lack of generalizability and responses subject to recall bias. Additionally, the cross-sectional survey and linked longitudinal clinical data do not allow for determination of causality.

Conclusion: Cumulative social risk was associated with long-term cancer-specific survival after treatment for Stage III colorectal cancer. Assessing social risk may help identify patients with colorectal cancer who are at higher risk of mortality to receive support programs designed to mitigate social disadvantage. See Video Abstract.

Keywords: Cancer-specific; Colorectal cancer; Mortality; Risk; Social determinants..

Copyright © The ASCRS 2025.

背景： 社会经济劣势与结直肠癌患者较差的临床结果广泛相关。针对这些普遍公共卫生问题的干预措施收效不一，可能与其基于汇总数据（例如平均邮政编码收入）和短期结果的发展有关，而不是基于个体层面的数据和有意义的长期癌症结局。

目的： 探讨个人及累积多重、同时存在的个体水平社会风险因素与晚期结直肠癌患者长期特异性生存率之间的关联。

设计： 前瞻性队列研究。

地点： 2011-2014年间，我们与佐治亚州和底特律的监测、流行病学及最终结果机构合作，对前一年诊断为III期结直肠癌的患者进行了调查。累积社会风险通过计算与结直肠癌特异性死亡率相关的显著因素（就业情况、保险、健康素养、收入和婚姻状况）之和来确定。

患者： 患有III期结直肠癌的患者。

主要结局指标： 从诊断到特异性癌症死亡的时间，经过年龄、种族、性别和化疗接受情况调整后，并以风险比及其95%置信区间的形式提供比较结果。

结果： 在1173名患者中，术前失业（1.76 [1.30-2.39]）、未投保或持有医疗补助保险（1.54 [1.12-2.11]）、低健康素养（1.40 [1.00-1.95]），年收入低于$50,000（1.34 [1.01-1.77]）以及单身状态（1.34 [1.02-1.77]）与较高的特异性癌症死亡率相关。累积风险分析显示，每个额外的社会风险因素都使调整后的特异性癌症死亡率增加24%（1.24 [1.12-1.37]）。

局限性： 本研究由于调查研究的特点而存在一些固有的限制，包括可能缺乏普遍适用性和回忆偏差的影响。此外，横断面调查与纵向临床数据的结合无法确定因果关系。

结论： 累积的社会风险与III期结直肠癌治疗后的长期特异性生存率相关联。评估社会风险有助于识别高死亡风险的结直肠癌患者，使他们能够接受旨在缓解社会劣势的支持项目。请参阅视频摘要。

关键词： 癌症特异性；结直肠癌；死亡率；风险；社会决定因素..