Socioeconomic gradients measured by the Yost index and colorectal cancer outcomes: a Surveillance, Epidemiology, and End Results-Medicare analysis.

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.