Abstract Background: Early-onset colorectal cancer (EOCRC) is increasing rapidly among adults aged 18–49 in the United States (U.S.), with Georgia showing disproportionately high mortality rates, especially in medically underserved communities. Sex and age significantly impact outcomes, with males experience higher mortality and survival rates varying by age group. However, limited studies have assessed cause-specific survival across different time interval while accounting for both sex and age simultaneously. Thus, we examined the relationships of sex and age specific groups with cause-specific survival for EOCRC. This regionally focused approach may offer broader implications for other states and regions across the U.S., particularly in the Southeast. Methods: We conducted a retrospective cohort analysis utilizing data from the 2000-2020 Georgia Cancer Registry. Sex (male or female) and age at diagnosis (18-29, 30-39, or 40-49 years) were exposures of interest. Causes-specific survival for CRC at 1-, 3, and 5-year intervals were our primary outcomes of interest. Patients’ survival time was measured in months from the date of diagnosis up to 12, 36, and 60 months of follow-up, censored at last known contact date or death due to other causes. Traditional Cox proportional hazards regression and Piecewise Cox regression models were performed to examine the mentioned association, adjusting for sociodemographic characteristics, geographic factors, and tumor features. Results: Among 11,935 EOCRC patients, males had lower 1- (89.4% vs. 91.9%), 3- (75.7% vs. 79.2%), and 5-year (69.7% vs. 74.3%) survival rates than female patients (all p-value 0.001). In adjusted analysis, regardless of survival intervals, male patients aged 30-39 years were more likely to die from CRC at 1-year (HR, 1.40; 95% CI, 1.08-1.82), 3-year (HR, 1.26; 95% CI, 1.06-1.49), 5-year (HR, 1.27; 95% CI, 1.09-1.48) than female aged 30-39 years, respectively. Our piecewise models also confirmed male patients aged 30-39 years were 33% more likely to die from CRC within 1 year interval. Similarly, male patients aged 40-49 years were more likely to die from CRC at 1-year (HR, 1.33; 95% CI, 1.16-1.53), 3-year (HR, 1.20; 95% CI, 1.10-1.32), and 5-year (HR, 1.22; 95% CI, 1.13-1.33) intervals than female patients aged 40-49 years, respectively. Conclusions: Age related disparities in EOCRC mortality were observed among male patients. Male patients aged 30-49 years demonstrated the greater risk of EOCRC death at 1-, 3- and 5- year intervals. In particular, the greater risk of EOCRC mortality at 1-year interval was observed among males aged 30-39 years. Prioritizing prevention and treatment strategies may reduce the risk of 1-year EOCRC mortality for males and 30-39 age group. Improving awareness of CRC risk and promoting healthy lifestyle for these groups may also be beneficial. Future research should evaluate multifaceted factors and identify/address specific barriers among young males to reduce disparities in EOCRC mortality in Georgia. Citation Format: Meng-Han Tsai, Yue Guan, Justin X. Moore, Humberto Sifuentes, Jorge Cortes. Time tells a different story: Sex and age-related differences in 1-, 3-, and 5-year survival for early-onset CRC in Georgia abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A131.
Tsai et al. (2025) studied this question.