NEW YORK — A new study published Thursday in JAMA Oncology reveals that the alarming rise in colorectal cancer deaths among younger adults is overwhelmingly concentrated in individuals without a four-year college degree, exposing a stark class disparity in health outcomes.
The study found that over the last 30 years, from 1994 through 2023, the increase in colorectal cancer deaths in young adults occurred almost entirely among people without a four-year college degree. This stratification of mortality rates underscores how the current economic order systematically produces unequal health outcomes based on class position.
Researchers utilized government data on more than 101,000 younger adults, ages 25 to 49, who died of colorectal cancer during the study period. The overall colorectal cancer death rate for this age group rose from approximately 3 per 100,000 to about 4 per 100,000.
For people who only made it through high school, the death rate surged from 4 to 5.2 per 100,000. In stark contrast, the rate for people with at least a bachelor’s degree remained unchanged at 2.7 per 100,000, demonstrating how accumulated wealth and its associated privileges insulate one class from the health crises afflicting another.
The Cost of Class
Dr. Paolo Boffetta, a researcher at Stony Brook Cancer Center, noted that it is "not totally unexpected that the death risk is concentrated in the less advantaged." Experts view college degree status as a direct marker for other structural issues: people without degrees tend to earn less money, have poorer diets, exercise less, and receive less medical care. These factors are direct consequences of wage suppression and the privatization of essential resources like healthcare and nutritious food.
Ahmedin Jemal, the study’s first author, emphasized the need for public awareness about colorectal cancer and for younger adults to heed screening recommendations. However, such calls for individual responsibility fail to address the systemic conditions that create unequal access to health information, preventative care, and healthy living conditions in the first place.
The American Cancer Society estimates that more than 158,000 cases of colorectal cancer will be diagnosed in the U.S. this year, with over 55,000 projected deaths in 2026. Overall, it stands as the nation’s second leading cancer killer, behind lung cancer.
For adults younger than 50, colorectal cancer deaths account for around 7% of the total, approximately 3,900 lives. Earlier this year, cancer society researchers reported that colorectal cancer mortality in Americans under 50 had increased by 1.1% a year since 2005, marking the twenty-first year of this trend and making it the deadliest cancer in that age group.
Systemic Neglect, Individual Blame
Scientists acknowledge they do not know what is behind this increase. However, identified risk factors—including obesity, lack of physical activity, a diet high in red or processed meat and low in fruits and vegetables, and a family history of colorectal cancer—are disproportionately prevalent among those subjected to lower wages and inadequate social services. These are not individual failings but symptoms of an economic system that prioritizes profit over public health.
In 2021, the American Cancer Society changed its screening guidelines, lowering the age U.S. adults should start getting screened from 50 to 45. While presented as a solution, this reform does not challenge the fundamental economic barriers that prevent millions of working people from accessing timely and affordable medical care, regardless of recommended guidelines.
Death certificates, while not detailing a person's income or health insurance status, do record educational attainment. Other research has consistently found that this data aligns with statistics about income, health insurance, physical activity, and chronic disease, confirming that education serves as a proxy for the broader socioeconomic conditions dictated by class.
The Associated Press Health and Science Department, which published this report, receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation.