Early-onset colorectal cancer hospitalizations in the United States: Metastatic burden, comorbidity, and mortality.

Abstract

e15567 Background: The incidence of early-onset colorectal cancer (CRC) is increasing in the United States; however, national data on disease stage, comorbidity burden, and outcomes among hospitalized patients are limited. This study examined age-stratified trends in hospitalized CRC, focusing on metastatic burden, comorbidities, and in-hospital outcomes. It was hypothesized that younger patients present with more advanced disease despite lower medical comorbidity, and that benign gastrointestinal diagnoses and lifestyle-related risk factors may contribute to diagnostic delay. Methods: A retrospective analysis of the Nationwide Inpatient Sample (2018–2022) identified adult hospitalizations with CRC. Survey weighting, stratification, and clustering were used. Patients were grouped by age ( < 45 versus 45–75 years). Metastatic disease, comorbidities, lifestyle-related factors (obesity, smoking, alcohol), and benign gastrointestinal diagnoses (IBS, hemorrhoids, abdominal pain) were identified by ICD codes. Outcomes included in-hospital mortality, length of stay, and hospital charges. Multivariable logistic regression was used to assess factors associated with mortality. Results: Among an estimated 2.0 million CRC hospitalizations, patients younger than 45 years represented a minority but exhibited a higher prevalence of metastatic disease compared to those aged 45–75 years (57.7% versus 47.6%). The younger cohort had a markedly lower prevalence of diabetes, hypertension, chronic kidney disease, coronary artery disease, chronic obstructive pulmonary disease, and cirrhosis. Obesity prevalence was similar across age groups, while smoking and alcohol use remained similar among younger patients. Benign gastrointestinal diagnoses associated with symptom misattribution were more prevalent among younger patients, including IBS, hemorrhoids, and chronic abdominal pain. Early-onset CRC hospitalizations were associated with lower in-hospital mortality (2.7% versus 4.0%) and similar length of stay and charges. Adjusted analyses indicated that mortality was primarily associated with age, acute organ dysfunction, severe illness, and cardiovascular comorbidities. Conclusions: Early-onset CRC hospitalizations show advanced metastatic disease despite lower comorbidity and mortality. High rates of benign gastrointestinal diagnoses and modifiable lifestyle factors may cause symptoms to be mistaken for noncancerous conditions, leading to delayed diagnosis. Prompt, vigilant diagnosis and targeted prevention are essential to improve outcomes.