Association of neighborhood socioeconomic status and ethnic diversity with failure to rescue in curative-intent colorectal cancer surgery: a population-based cohort study

Objective —To examine the association between neighborhood-level socioeconomic status (SES) and ethnic diversity and failure to rescue (FTR) after curative-intent colorectal cancer (CRC) resection.

Background of data — FTR is an outcome reflecting a system’s ability to detect and treat clinical deterioration after complications. However, little is known about how social characteristics influence FTR in oncologic populations.

Methods — We conducted a population-based retrospective cohort study of adults undergoing resection for stage I-III CRC (2007-2020). Exposures were SES and ethnic diversity defined by ecologic measures from census data. The primary outcome was FTR, defined as in-hospital death following a major postoperative complication. Logistic regression examined the association between exposures and FTR while adjusting for confounders. Subgroup analysis explored associations by cancer site and procedure setting.

Results — Among 60,470 patients included, FTR occurred in 1,158 (1.9%). Of those, 25.0% resided in the lowest SES neighborhood (5th quintile) versus 16.9% in the highest (1st quintile) (P<0.001), and 18.5% resided in the most ethnically diverse neighborhoods (5th quintile) versus 21.2% in the least (1st quintile, P=0.12). After adjustment, residing in the lowest SES (Odds Ratio, OR 1.26; 95% confidence interval, CI 1.05-1.52) or most ethnically diverse neighborhoods (OR 1.53, 95%CI 1.26-1.85) was associated with higher odds of FTR compared to patients residing in the highest SES or least ethnically diverse neighborhoods. These observations persisted in the colon but not rectal cancer subgroup and in the emergency but not elective setting.

Conclusion — These findings outline inequalities in post-operative outcomes by social characteristics pointing towards potential gaps in structures of care.