TOPLINE:

In a cross-sectional study of adults aged 25-49 years in the US, colorectal cancer (CRC) mortality rose from 1994 to 2023, primarily among those with 15 or fewer years of education, and educational disparities in mortality widened over time.

METHODOLOGY:

• The incidence and mortality associated with CRC has been rising among young adults in recent decades. However, whether mortality trends differ by markers of socioeconomic status such as educational attainment is unclear.
• Researchers conducted a cross-sectional study analyzing nationwide CRC mortality data obtained from the National Center for Health Statistics of individuals aged 25-49 years who died from CRC between January 1994 and December 2023 in the US.
• Trends in annual death rates were age-standardized to the 2000 US population and stratified by sex and educational attainment (≤ 12, 13-15, and ≥ 16 years of education).
• Researchers estimated mortality rate ratios and rate differences comparing individuals with ≤ 12 years vs ≥ 16 years of education by sex for 1994 and 2023.

TAKEAWAY:

• Overall, 101,037 individuals (mean age, 43.0 years; 55.4% men) died from CRC between 1994 and 2023, and CRC death rates rose from 3.2 per 100,000 in 1994 to 3.8 per 100,000 in 2023. For individuals with 12 or fewer years of education, rates rose from 4.0 to 5.2 per 100,000; for those with 13-15 years of education, rates rose from 2.3 to 3.5 per 100,000; and for those with 16 or more years of education, rates remained essentially unchanged at 2.7 per 100,000.
• Among men with 12 or fewer years of education, CRC death rates increased from 0.6% per year in 1994-2017 to 2.8% per year in 2017-2023, whereas rates among men with 16 or more years of education increased by only 1.4% per year between 2005 and 2023.
• Among women, the increase in CRC mortality was statistically significant only for those with 15 or fewer years of education, with an increase of 1.5% per year from 2011 to 2023 for those with 12 or fewer years of education and 1.6% per year from 1996 to 2023 for those with 13-15 years of education.
• Among individuals with 12 or fewer vs 16 or more years of education, the mortality rate ratio increased from 1.50 to 1.93 in men and from 1.55 to 1.81 in women, whereas absolute rate differences rose from 1.5 to 2.8 and from 1.3 to 2.0 deaths per 100,000, respectively.

IN PRACTICE:

“The increase in young-onset CRC mortality over the past decades in the US was confined largely to persons with lower educational attainment, suggesting a role of social determinants of health for the increasing burden of this disease,” the authors concluded in a research letter.

SOURCE:

The research letter, led by Ahmedin Jemal, DVM, PhD, Surveillance, Prevention, and Health Services Research, American Cancer Society in Atlanta, was published online in JAMA Oncology.

LIMITATIONS:

The study relied on self-reported or next-of-kin-reported data on educational attainment, which may have introduced reporting bias. The analysis lacked stratified estimates by race or ethnicity, insurance, and other social determinants of health owing to sparse data.

DISCLOSURES:

The study was supported by the Intramural Research Department of the American Cancer Society. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.