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. 2025 Apr 1;5(4):694-705.
doi: 10.1158/2767-9764.CRC-24-0503.

Social-Environmental Burden Is Associated with Increased Colorectal Cancer Mortality in Metropolitan Detroit

Natalie G Snider-Hoy  1   2 , R Blake Buchalter  3 , Theresa A Hastert  1   2 , Gregory Dyson  1 , Carina Gronlund  4 , Julie J Ruterbusch  1   2 , Ann G Schwartz  1   2 , Elena M Stoffel  5 , Laura S Rozek  6 , Kristen S Purrington  1   2
Affiliations

Social-Environmental Burden Is Associated with Increased Colorectal Cancer Mortality in Metropolitan Detroit

Natalie G Snider-Hoy et al. Cancer Res Commun. .

Abstract

Abstract: Neighborhood quality affects both socioeconomic factors and exposure to carcinogenic environmental pollutants, but the impacts of these factors on racial disparities in colorectal cancer mortality are not well described. We used the Centers for Disease Control and Prevention Environmental Justice Index social vulnerability module, environmental burden module (EBM), and the combined social–environmental score (SER) to assess relationships with colorectal cancer mortality by race and age in the Metropolitan Detroit Cancer Surveillance System. Among 13,505 patients with colorectal cancer [9,727 non-Hispanic White (NHW) and 3,778 non-Hispanic Black (NHB)], EBM quartile 4 versus 1 was more strongly associated with mortality among NHB early-onset (EO) cases than NHW EO cases [NHB: HR = 1.98, 95% confidence interval (CI), 1.20–3.26; NHW: HR = 1.40, 95% CI, 0.88–2.25]. SER quartile 4 versus 1 was more strongly associated with colorectal cancer mortality in EO (NHB: HR = 1.76, 95% CI, 0.93–3.31; NHW: HR = 1.53, 95% CI, 0.79–2.96) compared with later-onset cases (NHB: HR = 1.15, 95% CI, 0.87–1.52; NHW: HR = 1.39, 95% CI, 1.17–1.65) regardless of race. These associations in EO cases were strongest in colon tumors versus rectal tumors (EO EBM: colon HR = 2.08, 95% CI, 1.24–3.48 vs. rectum HR = 1.03, 95% CI, 0.64–1.66; EO SER: colon HR = 2.57, 95% CI, 1.38–4.79 vs. rectum HR = 0.84, 95% CI, 0.48–1.45). These results suggest the combination of socio-environmental burdens contributes to age and racial disparities in colorectal cancer mortality in metropolitan Detroit.

Significance: Understanding the role of environmental justice in cancer survivorship could influence policy decisions, aiding intervention practices.

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Conflict of interest statement

N.G. Snider-Hoy reports grants from the NCI during the conduct of the study. T.A. Hastert reports grants from the NCI during the conduct of the study and grants from the NCI and Michigan Health Endowment Fund outside the submitted work. A.G. Schwartz reports grants from the United States department of Health and Human Services during the conduct of the study. K.S. Purrington reports grants from the NIH during the conduct of the study and grants from the American Cancer Society and NIH outside the submitted work. No disclosures were reported by the other authors.

Figures

Figure 1
Figure 1
Racial distributions of patients by EJI quartiles (shown as counts). A, SVM, (B) EBM, and (C) SER.
Figure 2
Figure 2
Geographic distribution of EJI variables in metropolitan Detroit at the census tract level for (A) SVM raw scores categorized by quartile, (B) EBM raw scores categorized by quartile, and (C) combined SER raw scores categorized by quartile. For each variable, Q1 is depicted in light yellow, Q2 in light orange, Q3 in medium orange, and Q4 in dark orange. Raw score values corresponding to each quartile are shown in the legends. Census tracts without sufficient data to calculate scores are shown in black.
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