The cost of care: How insurance status and socioeconomic factors affect colorectal cancer outcomes in Appalachia.

106 Background: Colorectal cancer (CRC) is a leading cause of cancer mortality, with outcomes influenced by early detection and treatment access. In rural Appalachia, factors like insurance status, smoking, and family history contribute to delayed diagnosis and poorer outcomes for uninsured and underinsured populations. Addressing these disparities is key to improving CRC detection, treatment, and survival in underserved areas. Methods: A retrospective analysis was conducted using inpatient data from a community health setting in the Appalachian region, years 2020–2024, to identify patients with CRC. Descriptive statistics summarized sociodemographic factors, tumor biology, CEA levels, treatments, and clinical outcomes. Chi-square tests assessed associations between insurance status, smoking, alcohol use, family history, and outcomes. Logistic regression evaluated the independent effect of insurance on delayed diagnosis and treatment access, adjusting for confounders, with statistical significance set at p < 0.05. Results: Uninsured patients (8.7%) were more likely to present with advanced-stage CRC (74.4% stages III/IV) compared to those with Medicare/HMO (51.1%) (χ² = 27.42, p < 0.001) and had significantly higher rates of undocumented CEA data (56.4% vs. 48.2% Medicare, 42.2% HMO) (χ² = 6.14, p = 0.014). Smoking was also significantly associated with advanced disease at diagnosis (χ² = 4.91, p = 0.02), while alcohol use and family history had no significant impact. Logistic regression confirmed that uninsured status was statistically significant independent predictor of delayed diagnosis (OR 2.4, p = 0.003), which negatively affected overall survival (OS) and progression-free survival (PFS). Conclusions: In the Appalachian region, insurance status and socioeconomic barriers—such as limited healthcare access, financial hardship, smoking, and transportation issues—delay CRC diagnosis and treatment. Uninsured and Medicaid patients often present with advanced-stage disease due to limited access to screenings like colonoscopies and Fecal immune chemical tests, resulting in poorer overall and progression-free survival. Expanding Medicaid, improving access to low-cost screenings, deploying mobile clinics, and enhancing health literacy are key to reducing disparities and improving CRC outcomes in underserved populations.