Impact of socioeconomic status on patient characteristics and postoperative outcomes in colorectal cancer surgery: A retrospective cohort study.

BACKGROUND

Colorectal cancer remains among the most common malignancies worldwide and the second leading cause of cancer-related death. Prior studies suggest that socioeconomic deprivation is associated with higher incidence and poorer outcomes in colorectal cancer patients.

METHODS

We conducted a retrospective study of 476 patients who underwent colorectal cancer resection at a high-volume center in Germany between 2016 and 2023. Area-level socioeconomic status (SES) was estimated using a region-specific purchasing power index (PPI) derived from patients' residential postal codes. We retrospectively examined whether SES was associated with mode of presentation, perioperative course, postoperative complications, and oncologic outcomes. In addition, a prespecified exploratory subgroup analysis was performed by comparing patients in the highest 20% (top) and lowest 20% (bottom) of the cohort according to PPI distribution.

RESULTS

In the overall cohort, higher area-level SES was associated with emergency surgery. In the subgroup analysis, the top SES subgroup was also associated with older age and postoperative complications. We further observed significant associations between the bottom SES subgroup and both younger age at diagnosis and higher body mass index (BMI). No statistically significant association between SES and overall or disease-free survival was observed in our patient cohort.

CONCLUSIONS

In this single-center study, area-level SES was associated with distinct patient and perioperative profiles, but not with long-term oncologic outcomes. These findings suggest potentially actionable differences in risk profiles across SES strata, particularly regarding age at diagnosis, obesity, and complication burden.