Abstract 496P
Background
The incidence of colorectal cancer (CRC) is rising in younger adults, but evidence to support screening in adults younger than 50 years is limited. We examined patient characteristics, and geographic variation of CRC in adults 50 years and younger in a commercially insured cohort.
Methods
A retrospective cohort of patients with a first diagnosis of CRC was developed using the IBM® MarketScan® Research Database. Patients ages 18 to 50 years with continuous insurance enrollment of 12 months before and 6 months after diagnosis from 01 January 2013 to 31 December 2018 were assessed for cancer type, metastatic status, key comorbid conditions and US census region.
Results
Of 67,921 patients with first diagnosis of CRC, 10,577 (15.6%) were 18 to 50 years in the 5-year study period with the highest proportion (51.2%) and greatest percent increase across the 5 years (6.4% to 11.8%) was among the 46-50 year age group. Over the 5 year study period, the proportions of cancer types were colon (72.6%), rectal (25.6%), and colorectal without specific anatomic site (1.8%). More patients were females (52.5%) and most (46.0%) resided in the South compared to other regions. The most common co-morbidities were hypertension (25.5%), obesity (16.0%), and type 2 DM (9.0%). In patients 18 to 24 years, inflammatory bowel disease (IBD) and obesity were the most prevalent comorbidities (8.8% each). Metastatic CRC was present in 7.0% of patients with 50% detected in the 46-50 year age group.
Conclusions
In a cohort of US privately insured patients with an initial diagnosis of CRC, 15.6% were younger than 50 years. For patients 18-24 years, obesity and IBD were the most common co-morbidities. Also, 50% of patients with metastatic disease at presentation were between 46-50 years of age. Our results suggest that risk factors and burden of CRC may be unevenly distributed in the population. While our study had a sizeable sample, limitations include a retrospective design and transient enrollment in health plans. Our study highlights CRC in adults under 50 years as a significant health problem. Further studies are needed to evaluate the role of CRC screening and strategies for early detection in this patient population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
IBM Watson Health.
Funding
IBM Watson Health.
Disclosure
Y. Arriaga, H. Huang, S. Wang, E. Scheufele, I. Dankwa Mullan: Full/Part-time employment: IBM Watson Health. K. Rhee: Leadership role, Travel/Accommodation/Expenses, Shareholder/Stockholder/Stock options, Full/Part-time employment: IBM Watson Health. G. Jackson: Leadership role, Shareholder/Stockholder/Stock options, Full/Part-time employment: IBM Watson Health.