The impact of socioeconomic status on overall survival in patients with colorectal cancer: a systematic review and meta-analysis

Introduction: Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer-related mortality worldwide. Patients are typically diagnosed at an early stage due to widespread use of colonoscopy screenings and stool testing. Despite the efficacy of early detection in CRC, there are concerns about the accessibility of these treatments for patients of lower socioeconomic status (SES), which may lead to poorer outcomes and exacerbate health inequity. Patients and methods: We searched Medline and Embase from inception to 26 April 2024 to identify cohort studies comparing SES indicators and CRC outcomes. We computed hazard ratios (HRs) with accompanying 95% confidence intervals (CIs) for each study, and pooled the results using a random-effects meta-analysis. Quality assessment was carried out using Newcastle–Ottawa Quality Assessment Scale for cohort studies. Results: In this meta-analysis of 37 studies involving 2 017 509 patients, we analysed the impact of SES on overall survival in patients with CRC. All but three studies were conducted in high-income countries. Our main findings demonstrated that lower income (HR 1.16, 95% CI 1.08-1.23, P < 0.0001), lower educational level (HR 1.24, 95% CI 1.17-1.31, P < 0.0001), lower neighbourhood SES (HR 1.22, 95% CI 1.19-1.25, P < 0.0001), and lower insurance coverage (HR 1.29, 95% CI 1.25-1.32, P < 0.0001) had a negative impact on overall survival in patients with CRC. Conclusion: Lower income, educational level, insurance coverage, and neighbourhood SES had a negative impact on overall survival in patients with CRC. There is an urgent need to develop and implement interventions to reduce disparities in outcomes for patients with CRC who are of lower SES.