Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Socioeconomic gradients measured by the Yost index and colorectal cancer outcomes: a Surveillance, Epidemiology, and End Results-Medicare analysis.
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Worku Eshetu B, Woldesenbet Selamawit A, Pawlik Timothy M
Аннотация
BACKGROUND: Neighborhood socioeconomic context influences access to colorectal cancer (CRC) care and outcomes, yet its independent contribution to short-term surgical outcomes remains unclear. This study evaluated the associations between neighborhood-level Yost socioeconomic status (SES) and urgent presentation and short-term outcomes among older adults undergoing CRC surgery.
METHODS: Medicare beneficiaries aged 66 to 90 years who underwent colectomy or rectal resection for malignant CRC were identified from Surveillance, Epidemiology, and End Results-Medicare data (2006-2019). Census tract-level Yost SES quintiles were linked to patient records. Multivariable regression models assessed associations between SES and urgent presentation, index complications, and 90-day mortality, adjusting for demographic, clinical, and hospital characteristics. Sensitivity analyzes using the Social Vulnerability Index were performed.
RESULTS: Among 72,491 patients (77.4%, colon; 22.6%, rectal), lower neighborhood SES was associated with more acute presentations and worse short-term outcomes. Emergency diagnoses occurred more frequently in the lowest than in the highest SES quintile (16.7% vs 11.6%), and 90-day mortality was higher (11.0% vs 7.5%). In adjusted analyzes, higher SES was consistently protective, with lower odds of urgent presentation (quintile [Q]5 vs Q1: OR, 0.71; 95% CI, 0.67-0.76), index complications (OR, 0.81; 95% CI, 0.75-0.88), and 90-day mortality (OR, 0.74; 95% CI, 0.66-0.83). Urgent presentation strongly predicted complications (OR, 2.35; 95% CI, 2.24-2.46) and mortality (OR, 4.88; 95% CI, 4.58-5.21).
CONCLUSION: Lower neighborhood SES was independently associated with a higher likelihood of urgent CRC presentation, postoperative complications, and early mortality. Incorporating neighborhood socioeconomic context into CRC care delivery, risk adjustment, and equity-focused policy frameworks may improve outcomes for disadvantaged populations.
METHODS: Medicare beneficiaries aged 66 to 90 years who underwent colectomy or rectal resection for malignant CRC were identified from Surveillance, Epidemiology, and End Results-Medicare data (2006-2019). Census tract-level Yost SES quintiles were linked to patient records. Multivariable regression models assessed associations between SES and urgent presentation, index complications, and 90-day mortality, adjusting for demographic, clinical, and hospital characteristics. Sensitivity analyzes using the Social Vulnerability Index were performed.
RESULTS: Among 72,491 patients (77.4%, colon; 22.6%, rectal), lower neighborhood SES was associated with more acute presentations and worse short-term outcomes. Emergency diagnoses occurred more frequently in the lowest than in the highest SES quintile (16.7% vs 11.6%), and 90-day mortality was higher (11.0% vs 7.5%). In adjusted analyzes, higher SES was consistently protective, with lower odds of urgent presentation (quintile [Q]5 vs Q1: OR, 0.71; 95% CI, 0.67-0.76), index complications (OR, 0.81; 95% CI, 0.75-0.88), and 90-day mortality (OR, 0.74; 95% CI, 0.66-0.83). Urgent presentation strongly predicted complications (OR, 2.35; 95% CI, 2.24-2.46) and mortality (OR, 4.88; 95% CI, 4.58-5.21).
CONCLUSION: Lower neighborhood SES was independently associated with a higher likelihood of urgent CRC presentation, postoperative complications, and early mortality. Incorporating neighborhood socioeconomic context into CRC care delivery, risk adjustment, and equity-focused policy frameworks may improve outcomes for disadvantaged populations.