{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T02:27:40Z","timestamp":1768012060054,"version":"3.49.0"},"reference-count":45,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH T32","award":["#5T32CA163177-12"],"award-info":[{"award-number":["#5T32CA163177-12"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Socioeconomic status (SES) significantly influences outcomes in colorectal cancer (CRC) patients, with those from low-SES backgrounds facing worse prognoses. However, living in an affluent neighborhood may mitigate some of these disparities through environmental advantages. This study investigates whether Medicaid-insured CRC patients, as a proxy for low individual SES, experience better outcomes when residing in high-SES neighborhoods. Methods: Using the National Cancer Database, we examined Medicaid CRC patients, stratifying them by neighborhood SES indicators: median household income and education level. Patients in the highest and lowest quartiles of income and education were compared. Medicaid patients from the highest-SES neighborhoods were compared to the general population. Multivariable regression models analyzed 30- and 90-day postoperative mortality, overall survival (OS), and time from diagnosis to treatment initiation and surgery. Results: CRC patients in high-income neighborhoods began treatment earlier (coefficient \u22121.847, p = 0.015) and exhibited improved OS (HR 0.810, p &lt; 0.001) compared to those in low-income neighborhoods, irrespective of education level. Similarly, patients in high-education neighborhoods started treatment sooner (coefficient \u22123.926, p &lt; 0.001) and had better OS (HR 0.897, p &lt; 0.001). No differences were observed in time to surgery or postoperative mortality. Despite these advantages, Medicaid patients in high-income (HR 1.130, p &lt; 0.001) and high-education (HR 1.209, p = 0.002) areas still had worse OS compared to non-Medicaid patients. Conclusions: Higher neighborhood SES is associated with a significant survival benefit for Medicaid CRC patients, but these patients still lag behind their non-Medicaid counterparts. Understanding the mechanisms by which neighborhood SES influences cancer outcomes could inform targeted interventions to close the survival gap.<\/jats:p>","DOI":"10.3390\/cancers17091399","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T20:11:48Z","timestamp":1745352708000},"page":"1399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes for Medicaid Patients with Colorectal Cancer Are Improved in Affluent Neighborhoods, but Disparities Persist"],"prefix":"10.3390","volume":"17","author":[{"given":"Kaelyn C.","family":"Cummins","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad","family":"El Moheb","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-2872","authenticated-orcid":false,"given":"Chengli","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan J.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell","family":"Witt","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha M.","family":"Ruff","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Tsung","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3322\/caac.21820","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/gutjnl-2022-327736","article-title":"Global burden of colorectal cancer in 2020 and 2040: Incidence and mortality estimates from GLOBOCAN","volume":"72","author":"Morgan","year":"2023","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1053\/j.gastro.2023.06.033","article-title":"AGA Clinical Practice Update on Risk Stratification for Colorectal Cancer Screening and Post-Polypectomy Surveillance: Expert Review","volume":"165","author":"Issaka","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.6004\/jnccn.2024.0001","article-title":"Colon Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology","volume":"22","author":"Benson","year":"2024","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"366","DOI":"10.6004\/jnccn.2024.0041","article-title":"NCCN Guidelines\u00ae Insights: Rectal Cancer, Version 3.2024","volume":"22","author":"Benson","year":"2024","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1136\/jech.2006.046094","article-title":"Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998\u20132000","volume":"61","author":"Turrell","year":"2007","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/JTO.0000000000000417","article-title":"Neighborhood Deprivation and Lung Cancer Incidence and Mortality: A Multilevel Analysis from Sweden","volume":"10","author":"Li","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e238908","DOI":"10.1001\/jamanetworkopen.2023.8908","article-title":"Neighborhood Disadvantage and Breast Cancer\u2013Specific Survival","volume":"6","author":"Goel","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s10552-007-9084-7","article-title":"Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: A multilevel analysis","volume":"19","author":"Bentley","year":"2007","journal-title":"Cancer Causes Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1038\/bjc.1995.170","article-title":"Socioeconomic status and colon cancer incidence: A prospective cohort study","volume":"71","author":"Brandt","year":"1995","journal-title":"Br. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4187","DOI":"10.1002\/cncr.25195","article-title":"Neighborhood socioeconomic status and behavioral pathways to risks of colon and rectal cancer in women","volume":"116","author":"Kim","year":"2010","journal-title":"Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3636","DOI":"10.1002\/cncr.26677","article-title":"Socioeconomic status and the risk of colorectal cancer","volume":"118","author":"Doubeni","year":"2012","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1002\/cncr.31832","article-title":"Ten-year change in neighborhood socioeconomic status and colorectal cancer","volume":"125","author":"Zhang","year":"2018","journal-title":"Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1023\/A:1026321923883","article-title":"Race, socioeconomic status and stage at diagnosis for five common malignancies","volume":"14","author":"Schwartz","year":"2003","journal-title":"Cancer Causes Control"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"On behalf of Danish Colorectal Cancer Group, Frederiksen, B.L., Osler, M., Harling, H., and J\u00f8rgensen, T. (2008). Social inequalities in stage at diagnosis of rectal but not in colonic cancer: A nationwide study. Br. J. Cancer, 98, 668\u2013673.","DOI":"10.1038\/sj.bjc.6604215"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e1730","DOI":"10.1002\/onco.13908","article-title":"Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer","volume":"26","author":"Salem","year":"2021","journal-title":"Oncologist"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.surg.2024.05.031","article-title":"Low neighborhood socioeconomic status is associated with poor outcomes in young adults with colorectal cancer","volume":"176","author":"Ko","year":"2024","journal-title":"Surgery"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1001\/jamaoncol.2024.3666","article-title":"Molecular, Socioeconomic, and Clinical Factors Affecting Racial and Ethnic Disparities in Colorectal Cancer Survival","volume":"10","author":"Yousef","year":"2024","journal-title":"JAMA Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2951","DOI":"10.1002\/ijc.28624","article-title":"Socioeconomic deprivation and cancer survival in Germany: An ecological analysis in 200 districts in Germany","volume":"134","author":"Jansen","year":"2013","journal-title":"Int. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2808","DOI":"10.1111\/ans.18081","article-title":"Socioeconomic disadvantage and its impact on colorectal cancer in Australia: A scoping review","volume":"92","author":"Tham","year":"2022","journal-title":"ANZ J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101654","DOI":"10.1016\/j.canep.2019.101654","article-title":"Associations between area-level deprivation, rural residence, physician density, screening policy and late-stage colorectal cancer in Canada","volume":"64","author":"Blair","year":"2020","journal-title":"Cancer Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102394","DOI":"10.1016\/j.canep.2023.102394","article-title":"Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996\u20132012","volume":"85","author":"Silva","year":"2023","journal-title":"Cancer Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"521","DOI":"10.2188\/jea.JE20220066","article-title":"Association of Socioeconomic Status Assessed by Areal Deprivation With Cancer Incidence and Detection by Screening in Miyagi, Japan Between 2005 and 2010","volume":"33","author":"Kaneko","year":"2023","journal-title":"J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e55011","DOI":"10.2196\/55011","article-title":"Socioeconomic Disparities in Six Common Cancer Survival Rates in South Korea: Population-Wide Retrospective Cohort Study","volume":"10","author":"Lee","year":"2024","journal-title":"JMIR Public Health Surveill."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/j.1467-842X.2006.tb00088.x","article-title":"Trends in colorectal cancer mortality by ethnicity and socio-economic position in New Zealand, 1981\u201399: One country, many stories","volume":"30","author":"Shaw","year":"2006","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1016\/j.ejca.2008.06.020","article-title":"Social inequality and incidence of and survival from cancers of the colon and rectum in a population-based study in Denmark, 1994\u20132003","volume":"44","author":"Egeberg","year":"2008","journal-title":"Eur. J. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0140-6736(21)00001-5","article-title":"National Institute for Health Research Global Health Research Unit on Global S. Global variation in postoperative mortality and complications after cancer surgery: A multicentre, prospective cohort study in 82 countries","volume":"397","author":"GlobalSurg","year":"2021","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1002\/cncr.22826","article-title":"Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer","volume":"110","author":"Du","year":"2007","journal-title":"Cancer"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1353\/hpu.0.0263","article-title":"Cancer Survival Disparities by Race\/Ethnicity and Socioeconomic Status in New Jersey","volume":"21","author":"Niu","year":"2010","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.2105\/AJPH.2013.301572","article-title":"Geographic Residency Status and Census Tract Socioeconomic Status as Determinants of Colorectal Cancer Outcomes","volume":"104","author":"Hines","year":"2014","journal-title":"Am. J. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tannenbaum, S.L., Hernandez, M., Zheng, D.D., Sussman, D.A., and Lee, D.J. (2014). Individual- and Neighborhood-Level Predictors of Mortality in Florida Colorectal Cancer Patients. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0106322"},{"key":"ref_32","first-page":"168","article-title":"Disparities in cancer incidence and mortality by area-level socioeconomic status: A multilevel analysis","volume":"69","author":"Sheppard","year":"2014","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"15641","DOI":"10.1007\/s00432-023-05344-3","article-title":"Socioeconomic status on survival outcomes in patients with colorectal cancer: A cross-sectional study","volume":"149","author":"Zhu","year":"2023","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1097\/XCS.0000000000001214","article-title":"American College of Surgeons Cancer Program Annual Report from 2021 Participant User File","volume":"240","author":"Habermann","year":"2024","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1001\/jama.2022.14791","article-title":"The US Medicaid Program","volume":"328","author":"Donohue","year":"2022","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/MLR.0000000000001154","article-title":"Developing and Validating a Measure to Estimate Poverty in Medicare Administrative Data","volume":"57","author":"Lewis","year":"2019","journal-title":"Med. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1200\/JOP.2012.000640","article-title":"Referral and Treatment Patterns Among Patients with Stages III and IV Non\u2013Small-Cell Lung Cancer","volume":"9","author":"Goulart","year":"2013","journal-title":"J. Oncol. Pract."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1158\/1055-9965.EPI-09-0104","article-title":"Socioeconomic and Racial Patterns of Colorectal Cancer Screening among Medicare Enrollees in 2000 to 2005","volume":"18","author":"Doubeni","year":"2009","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Lian, M., Schootman, M., and Yun, S. (2008). Geographic variation and effect of area-level poverty rate on colorectal cancer screening. BMC Public Health, 8.","DOI":"10.1186\/1471-2458-8-358"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3222","DOI":"10.1245\/s10434-024-15029-x","article-title":"Association of COVID-19 Pandemic with Colorectal Cancer Screening: Impact of Race\/Ethnicity and Social Vulnerability","volume":"31","author":"Khan","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1023\/A:1008999232442","article-title":"Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men","volume":"11","author":"Platz","year":"2000","journal-title":"Cancer Causes Control"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Aleksandrova, K., Pischon, T., Jenab, M., Bueno-De-Mesquita, H.B., Fedirko, V., Norat, T., Romaguera, D., Kn\u00fcppel, S., Boutron-Ruault, M.-C., and Dossus, L. (2014). Combined impact of healthy lifestyle factors on colorectal cancer: A large European cohort study. BMC Med., 12.","DOI":"10.1186\/s12916-014-0168-4"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"702","DOI":"10.14309\/ajg.0000000000002065","article-title":"Changes in Lifestyle and Risk of Colorectal Cancer in the European Prospective Investigation into Cancer and Nutrition","volume":"118","author":"Botteri","year":"2022","journal-title":"Am. J. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e015619","DOI":"10.1136\/bmjopen-2016-015619","article-title":"The association of dietary quality with colorectal cancer among normal weight, overweight and obese men and women: A prospective longitudinal study in the USA","volume":"7","author":"EWaring","year":"2017","journal-title":"BMJ Open"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:19:38Z","timestamp":1760030378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/9\/1399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":45,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["cancers17091399"],"URL":"https:\/\/doi.org\/10.3390\/cancers17091399","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,22]]}}}