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Key factors included sex, race\/ethnicity, and rurality. Our main outcomes were whether patients started treatment, and which types they received. Multivariable logistic regression models were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of total 82,427 patients, males (54.9%, p=0.097), racial minorities (0.8%-23.3%, p&lt;0.001), and patients in all urban areas (70.7%; p&lt;0.001) had higher rates of no treatment. Adjusted analysis showed that male patients had16%-19% lower odds of receiving surgery regardless of rurality (p&lt;0.05) compared with female patients. In all\/mostly urban areas, Black patients were found to had 17%-41% lower odds of receiving any treatment modalities (p&lt;0.05); Hispanic patients had 11%-24% lower odds of receiving any treatment modalities (mostly urban: OR, 0.76; 95% CI, 0.60-0.95) or surgery alone (all urban: OR, 0.89; 95% CI, 0.84-0.95) compared with White patients. In rural areas, 33% and 34% lower odds of receiving radiation treatment were found among American Indian (AI)\/Alaska Native (AN) (OR, 0.67; 95% CI, 0.46-0.98) and Asian\/Pacific Islander (PI) patients (OR, 0.66; 95% CI, 0.44-0.99) compared with White patients, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Disparities in receipt of surgery treatment were observed in males regardless of rurality. Black and Hispanic patients in urban areas had lower treatment use, while AI\/AN and Asian\/PI patients in rural areas were less likely to start radiation. Targeted approaches for specific groups are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748261433621","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:39:46Z","timestamp":1776314386000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic and Demographic Disparities in Receipt of Treatment for Early-Onset Colorectal Cancer"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6511-156X","authenticated-orcid":false,"given":"Meng-Han","family":"Tsai","sequence":"first","affiliation":[{"name":"Augusta University"},{"name":"Augusta University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1704-0466","authenticated-orcid":false,"given":"Steven S.","family":"Coughlin","sequence":"additional","affiliation":[{"name":"Augusta University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Cortes","sequence":"additional","affiliation":[{"name":"Augusta University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33916"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1756"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/edbk_350241"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells10051018"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.734998"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1621"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2015.08.031"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-023-01967-0"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.10.038"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.12539"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.05339.x"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.Epi-20-1728"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.29247"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003842"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.00539"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-023-10528-8"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2023.102441"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181beb42a"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12128"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6614a1"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.Epi-17-0092"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-4815-5"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.56875\/2589-0646.1061"},{"key":"e_1_3_6_25_2","unstructured":"SEER Program Coding and Staging Manual 2021 Appendix A- County Codes. 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