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Background: Early-onset colon cancer (EOCC) has increasing incidence and disproportionately affects African-Americans. This analysis aims to compare EOCC survival among Black and White patients after matching relevant socio-demographic factors and stage., Methods: The 2004-2017 NCDB database was queried for Black and White patients, age<50, who underwent colectomy for adenocarcinoma. A one-to-one match on race was performed based on sociodemographic factors and disease stage (I-IV). Five-year survival differences were analyzed with Cox proportional hazards models., Results: 5322 Black-White matched pairs were analyzed. Compared to White patients, Black patients averaged more days to surgery (19 ​± ​68 vs 16 days ​± ​32, p ​< ​0.001) and to chemotherapy (63 ​± ​8 vs. 57 ​± ​39, p ​< ​0.001). Black stage III patients were 20% less likely to receive chemotherapy (OR 0.8, 95% CI 0.7-0.9, p ​= ​0.0006), and had a 17% increased rate of death (HR 1.17, 95% CI 1.0-1.3, p ​= ​0.01) after adjusting for sex, comorbidity score, tumor location and chemotherapy., Conclusions: Black patients with stage 3 EOCC are less likely to receive chemotherapy and have worse survival. Further evaluation is warranted to identify potential factors driving these observed., (Copyright © 2023 Elsevier Inc. All rights reserved.)