P1317 - Life and Death in the Mountains: An Examination of Survival from Early Onset Colorectal Cancer in Appalachia

Andrew H. Mims, MD, William K. Oelsner, MD, Aparna P. Shreenath, MD, PhD, Maaz Sohail, MD, Steven Kessler, DO, George Philips, MD, Jensen Hyde, MD, MPH
University of Tennessee Health Science Center College of Medicine, Chattanooga, TN

Introduction: Appalachia is a cultural and geographic region encompassing 205,000 square miles in the Eastern United States extending from southern New York to Mississippi with a population of roughly 25 million people. Much of its population remains remote, with significant and growing healthcare disparities compared to the rest of the nation. While incidence of Early Onset Colorectal Cancer (EOCRC) is rising across the United States, a disproportionate number of ‘hot spots’ have been identified within the Appalachian region. Survival from EOCRC in Appalachia, however, has not been well described to date.

Methods: A retrospective cohort analysis of 61,050 patients extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database was performed to examine relative survival rates for patients with EOCRC in Appalachian and Non-Appalachian patients. The analysis included patients aged 20-49, with ICD-0-3/WHO 2008 Microscopically confirmed Malignant Colon and Rectal Cancer, from 2000-2016. “Appalachian” was defined as those patients residing in counties included within the Appalachian Regional Commission’s charter. 3,651 Appalachian patients were compared to 57,399 Non-Appalachian patients for observed survival at 12-month intervals for 120 months. Survival plots where created using Kaplan Meier method, and 95% confidence intervals were calculated.

Results: At month 72, 61.85% [60.03-63.62] of Appalachians survived compared with 64.30% [63.86-64.74] non-Appalachians. At month 120, 56.00% [54.02 – 57.93] Appalachians survived compared with 58.50% [58.01 – 58.98] Non-Appalachians. A significant difference in survival was found beginning at month 72 and continued through month 120.

Discussion: Appalachian residents have decreased survival from EOCRC compared to non-Appalachians. Appalachia as a region suffers from high rates of poverty, low educational attainment, increased tobacco abuse, and decreased access to primary care. Future studies examining the impact of these social determinates of health on survival in Early Onset Colorectal Cancer are warranted.



Disclosures:


Andrew H. Mims, MD, William K. Oelsner, MD, Aparna P. Shreenath, MD, PhD, Maaz Sohail, MD, Steven Kessler, DO, George Philips, MD, Jensen Hyde, MD, MPH. P1317 - Life and Death in the Mountains: An Examination of Survival from Early Onset Colorectal Cancer in Appalachia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.