Household Income is Independently Associated with Overall and Cancer-Specific Survival After Proctectomy for Rectal Cancer; a Surveillance, Epidemiology, and End Results-based Analysis

Highlights•Patients with income <$50,000 had shorter restricted overall and cancer-specific survival than average and above-average income groups.•Adjusted for other factors, low income was an independent predictor of overall and cancer-specific mortality, compared to above-average income.•Low income was associated with worse survival in rectal cancer, independent of other possible confounding factors.AbstractBackgroundWe assessed association between household income, overall survival (OS), and cancer-specific survival (CSS) after proctectomy for rectal cancer.MethodsPopulation-based cohort study included stage I-III rectal adenocarcinoma patients who underwent proctectomy (2010-2020), subdivided by household income at diagnosis [low (<$50,000), average ($50,000-74,999), above-average (≥ $75,000)] and compared.ResultsOf 39,185 patients (59% male; mean age 60.4), 12.5% had low, 48.1% had average, and 39.4% had above-average income. Low-income patients were more often Black, rural dwellers, and undergone total proctectomy (OR: 1.49, p<0.001). Income <$50,000 patients had shorter restricted mean OS (p<0.001) and CSS (p<0.001) than the other groups. Adjusted for other factors, low-income was an independent predictor of OS (HR: 1.31, 95%CI: 1.22-1.41) and CSS (HR: 1.31, 95%CI: 1.21-1.43), compared to above-average.ConclusionsBlack patients and rural dwellers more often had <$50,000 income. Low-income increased odds of undergoing non-restorative surgery for rectal cancer and reduced OS and CSS.