Abstract B141: Social determinants of health and early-onset colorectal cancer diagnosis: Evidence from the All of Us Research Program

Abstract

Early-onset colorectal cancer (EOCRC), diagnosed before age 50, is one of leading cancer diagnoses among young adults in the United States (U.S.). Social determinants of health (SDoH) are important factors influencing CRC risk and diagnosis. Individuals facing disadvantages in 1) healthcare access/quality, 2) education access/quality, 3) economic stability, 4) neighborhood/built environment, and 5) social/community context may experience greater risks for later stage CRC diagnosis and outcomes. However, most research examining the impact of SDoH on CRC has evaluated CRC populations broadly, without specifically focusing on younger adults. Thus, we examined the associations between overall SDoH burden and its five domains with EOCRC diagnosis among a large community-dwelling sample of U.S. adults. We conducted a retrospective cohort analysis using the All of Us Registered Tier Dataset v8, including data through October 1, 2023, among participants aged 18 to 90 years. The primary exposures were overall SDoH burden and the mentioned five SDoH domains. SDoH measures were classified as advantaged or disadvantaged based on the 75th percentile of 96 SDoH items. Our primary outcome was CRC diagnosis identified using ICD-10 codes, with EOCRC defined using age at diagnosis (< 50 years). Multivariable logistic regression models were used to examine the associations. Among 156,629 eligible participants, 688 were diagnosed with CRC, including 100 (14.5%) cases of EOCRC diagnoses. Compared with CRC patients diagnosed at age ≥50 years, those with EOCRC had a higher prevalence of disadvantaged overall SDoH (25.0% vs. 12.9%), healthcare access/quality (28.0% vs. 14.6%), economic stability (47.0% vs. 35.7%), and social/community context (34.0% vs. 16.0%) (all ps < 0.05). In the overall cohort, disadvantaged overall SDoH (OR=0.68, 95% CI: 0.54-0.85), healthcare access/quality (OR=0.76, 95% CI: 0.61-0.94), education access/quality (OR = 0.68, 95% CI: 0.57-0.81), economic stability (OR=0.82, 95% CI: 0.69-0.98), and social/community context (OR=0.78, 95% CI: 0.63-0.95) were associated with lower odds of CRC diagnosis after covariate adjustments. However, among CRC cases, unadjusted analyses showed that disadvantaged overall SDoH (OR=2.25, 95% CI: 1.33-3.71), healthcare access/quality (OR=2.27, 95% CI: 1.37-3.69), economic stability (OR=1.60, 95% CI: 1.04-2.45), and social/community context (OR=2.71, 95% CI: 1.68-4.31) were associated with a 1.6- to 2.7-fold greater odds of EOCRC diagnosis. Among adults diagnosed with CRC, disadvantaged overall SDoH, healthcare access, economic stability, and social/community context were associated with a greater odd of EOCRC diagnosis. Our findings suggest that several social disadvantages may contribute to earlier CRC onset and highlight the importance of addressing SDoH related barriers in EOCRC prevention and early detection strategies. Future research with more granular SDoH measures and larger EOCRC cases is warranted to further elucidate the observed associations. Meng-Han Tsai, Yunqi Liao, Sydney P. Howard, Kristen McQuerry, Avinash S. Bhakta, Jessica L. Burris, Li Chen, Jorge Cortes, Justin X. Moore. Social determinants of health and early-onset colorectal cancer diagnosis: Evidence from the All of Us Research Program [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr B141.