27 Background: Recent studies have shown an increasing incidence of colorectal cancer (CRC) among young patients. This study investigates clinical outcomes and healthcare utilization among young (<50) versus average onset (≥50) CRC patients admitted to hospitals in New York State (NYS). Methods: We performed a retrospective analysis using the Statewide Planning and Research Cooperative System (SPARCS) database from 2017 to 2022. Patients were divided into two groups: young-onset colorectal cancer patients (YOCRC, <50 years) and average onset colorectal cancer patients (AOCRC, ≥50 years). The study population was further stratified by demographic and clinical characteristics. All associations were compared using the Kruskal-Wallis test, along with multivariate linear and logistic regression in RStudio version 4.4.1, at a significance level of ≤0.05. Clinical characteristics, including severity of illness and risk of mortality, were defined using the All Patient Refined (APR) grading system. Results: A total of 9,904 patients were identified (948 YOCRC and 8,956 AOCRC) with a primary admitting diagnosis of CRC from 2017 to 2022. In comparing the two age groups, AOCRC patients had a higher proportion of White, and female patients, whereas the YOCRC group included a higher proportion of Black and male patients (p<0.001). The median length of stay was greater for AOCRC patients (5 days) compared to YOCRC patients (4 days), p<0.001. Both age groups showed an upward trend in total cost of stay in the recent years. AOCRC patients were more likely to have increased severity of illness graded as major-extreme (60% vs 48%), while a higher proportion of YOCRC patients were classified as minor-moderate disease (51% vs 40%), p<0.001. Similarly, AOCRC patients experienced a higher risk of mortality compared to YOCRC patients (p<0.001). Regarding procedures, AOCRC patients needed more transfusions (13%) than YOCRC patients (9.3%), p<0.001. YOCRC patients were also more likely to be discharged home (71% vs 46%), while AOCRC patients often required home health services or skilled nursing (p<0.001). Notably, while the risk of mortality was higher for AOCRC patients, it has been decreasing overall from 2017 to 2022 [OR 0.92 (95% CI: 0.84-0.99), p=0.039]. Conclusions: AOCRC patients experienced greater severity of disease, higher mortality risk, and required more assistive care at discharge compared to YOCRC patients. The total cost of hospital stays has been rising for both groups. Policies focused on earlier outpatient interventions may help reduce the burden of inpatient care and rising costs.
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