Multilevel insights into obesity, race/ethnicity, and survival in early-onset colorectal cancer in Georgia.

PURPOSE: To examine how county-level obesity status affects early-onset colorectal cancer (EOCRC) survival across racial groups and survival timeframes in Georgia.

METHODS

We conducted a retrospective cohort study using data from the 2010 to 2020 Georgia Cancer Registry, linked with County Health Rankings. The primary exposures were race/ethnicity and county-level obesity rates. Outcomes were survival time from diagnosis to 12, 36, and 60 months. Traditional and piecewise Cox regression models were used.

RESULTS

Among 6291 patients, 63.4% lived in high-obesity areas, and 53.3% were White patients. White patients living in high-obesity areas had significantly lower 3-year (76.6% vs 81.1%; p = 0.002) and 5-year (71.3% vs 75.7%; p = 0.001) survival rates. Adjusted analysis showed that patients living in high-obesity areas were 14% more likely to die from CRC than those not living in these areas at both 3- (95% CI, 1.02-1.28) and 5-year (95% CI, 1.03-1.27) intervals, whereas White patients specifically were 32% (95% CI, 1.11-1.54) and 33% (95% CI, 1.13-1.50) more likely to die from CRC. Piecewise models revealed a 29% increased risk of CRC mortality within 1-3 years (95% CI, 1.11-1.50), with subgroup analysis showing an even higher 51% risk for White patients during the same interval (95% CI, 1.21-1.89).

CONCLUSIONS

Findings suggest that mortality risk varies over time, with elevated risk in the first 1-3 years for White patients in high-obesity areas. Targeted efforts aimed at promoting healthy lifestyles and investing in community resources that foster healthier living may reduce early mortality.