Household income is independently associated with overall and cancer-specific survival after proctectomy for rectal cancer: A surveillance, epidemiology, and end results-based analysis

Sameh Hany Emile; Nir Horesh; Zoe Garoufalia; Rachel Gefen; Justin Dourado; Anjelli Wignakumar; Steven D Wexner

doi:10.1016/j.amjsurg.2025.116191

Household income is independently associated with overall and cancer-specific survival after proctectomy for rectal cancer: A surveillance, epidemiology, and end results-based analysis

Am J Surg. 2025 Jan 9:242:116191. doi: 10.1016/j.amjsurg.2025.116191. Online ahead of print.

Authors

Sameh Hany Emile¹, Nir Horesh², Zoe Garoufalia³, Rachel Gefen⁴, Justin Dourado³, Anjelli Wignakumar³, Steven D Wexner⁵

Affiliations

¹ Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
² Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of Surgery and Transplantation, Sheba Medical Center and Faculty of Medicine, Ramat-Gan, Israel.
³ Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
⁴ Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
⁵ Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA. Electronic address: [email protected].

PMID: 39823655
DOI: 10.1016/j.amjsurg.2025.116191

Abstract

Background: We assessed association among household income, overall survival (OS), and cancer-specific survival (CSS) after proctectomy for rectal cancer.

Methods: Population-based cohort study included stage I-III rectal adenocarcinoma patients who underwent proctectomy (2010-2020), subdivided by household income at diagnosis [low (<$50,000), average ($50,000-74,999), above-average (≥$75,000)] and compared.

Results: Of 39,185 patients (59 % male; mean age 60.4), 12.5 % had low, 48.1 % had average, and 39.4 % had above-average income. Low-income patients were more often Black, rural dwellers, and undergone total proctectomy (OR: 1.49, p < 0.001). Income <$50,000 patients had shorter restricted mean OS (p < 0.001) and CSS (p < 0.001) than the other groups. 5-year OS (70.5 % vs. 73.6 % vs. 82.3 %, p < 0.001) and CSS (78.3 % vs. 80.6 % vs. 87.2 %, p < 0.001) were significantly lower in the low-income group than the average and above-average income groups. Adjusted for other factors, low-income was an independent predictor of OS (HR: 1.31, 95%CI: 1.22-1.41) and CSS (HR: 1.31, 95%CI: 1.21-1.43), compared to above-average.

Conclusions: Black patients and rural dwellers more often had <$50,000 income. Low-income increased odds of undergoing non-restorative surgery for rectal cancer and reduced OS and CSS.

Keywords: Analysis; Household income; Rectal cancer; SEER; Survival.