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Background: Young‐onset gastrointestinal malignancies appear to be increasing in incidence. There are limited data on young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). Methods: The study comprised patients with PBA (pancreatic adenocarcinoma, intra‐, and extra‐hepatic cholangiocarcinoma) and included in the National Cancer Database (NCDB) between 2004 and 2017. YO‐PBA was defined as a diagnosis at age less than 50 years. Logistic regression to assess factors associated with YO‐PBA status, and cox proportional hazards modeling to associate relevant factors with overall survival was performed. Results: The study cohort comprised 360,764 patients, with 20,822 (5.8%) YO‐PBA. YO‐PBA was associated with (p‐values<0.0001 for all): male sex (6.3% YO‐male out of all male patients vs. 5.2% YO‐female, OR 1.29, 95% CI 1.25–1.33), Black race (7.9% YO‐Black vs. 5.0% YO‐White, OR 1.72, 95% CI 1.64–1.80), lower income (6.4% YO‐lowest household income based group vs. 5.5% highest, OR 1.08, 95% CI 1.03–1.13). YO‐PBA were more likely to present with stage‐IV disease (6.4% YO‐Stage IV of all stage IV vs. 5.4% YO‐Stage I–III, OR 1.25, 95% CI 1.21–1.29 p‐value < 0.0001). Factors associated with overall survival (OS) in non‐operable patients included—sex ‐ male vs. female, HR 1.12 (95% CI 1.08–1.15); race ‐ Black vs. White, HR 1.23 (95% CI 1.06–1.42); income group ‐ lowest vs. highest, HR 1.33 (95% CI 1.27–1.39), and treatment center type ‐ academic vs. nonacademic center, HR 0.87 (95% CI 0.85–0.90). Conclusions: Socioeconomic factors significantly impact incidence and outcomes for young‐onset pancreaticobiliary adenocarcinoma (YO‐PBA). More work is needed to help understand the mechanisms involved while addressing the disparities. [ABSTRACT FROM AUTHOR]

Background: The incidence of colorectal cancer (CRC) in patients under age 50 is rising for unclear reasons. We examined the effects of socioeconomic factors on outcomes for patients with early‐onset CRC compared to late‐onset CRC. Methods: Patients with CRC from 2004 to 2015 in the National Cancer Database were included and categorized by age (under or over 50 years). Differences in demographic and socioeconomic factors, disease characteristics, and survival outcomes between early‐onset versus late‐onset CRC patients were assessed by Chi‐squared test and Cox models. Results: The study population included 1,061,204 patients, 108,058 (10.2%) of whom were under age 50. The proportion of patients diagnosed under age 50 increased over time: 9.4% in 2004–2006, 10.1% in 2007–2009, 10.5% in 2010–2012, and 10.7% in 2013–2015 (p < 0.0001). Early‐onset CRC patients were more likely to be Black (15.1% vs. 11.3%) or Hispanic (8.6% vs. 4.6%) and to present with stage 4 disease (24.9% vs. 17.0%), p < 0.0001 for all. Black patients had the worst median OS (58.3 months) compared to White (67.0 months), Hispanic (91.6 months), or Asian (104.9 months) patients, p < 0.0001. Within the subgroup of early‐onset CRC patients with private insurance, Black patients had worse OS compared to White patients, even in communities with higher income and education status. Conclusions: Early‐onset CRC continues to increase. Patients with early‐onset CRC are more likely to be Black or Hispanic and to present with stage 4 cancer. Early‐onset Black patients showed worse OS compared to White patients in all income subgroups, even with private insurance. [ABSTRACT FROM AUTHOR]