By Emily Joshu

Young Americans living in rural, impoverished areas the most likely to die from colon cancer, a study suggests. Doctors in the US have already had trouble spotting colorectal cancer in young people, as they are not typically at risk for the disease.

But in rural and poor areas, the problem is even worse, as residents have fewer doctors, longer wait times, and are more likely to have unhealthy lifestyles, all of which raise the risk of developing cancer.

In the new study, researchers from Augusta University in Georgia looked at nearly 60,000 patients with early-onset colorectal cancer, meaning they were under age 50.

Comparing federal cancer and poverty data, the team found that Americans ages 20 to 49 were up to one and a half times more likely to die from colorectal cancer if they lived in rural, poverty-stricken areas than people in wealthier urban areas.

Other recent research has also shown that people in richer, more populated areas are more likely to have their disease caught earlier, making it more easily treatable.

With these findings in mind, data on colorectal cancer rates in young people across the US was compiled by state and county, even though county-by-county data is limited.

The maps reveal that young people in states like Kentucky, West Virginia, and Louisiana recorded the most cases of early-onset colorectal cancer. And rural counties in Florida, Arkansas, and West Virginia had the highest incidences.

Meanwhile, counties in states like California, New York, and the coastal north east, which tend to have higher incomes, recorded lower rates of young-onset colorectal cancer.

This form of cancer, in particular, is thought to be heavily influenced by diet, alcohol consumption, and sedentary lifestyles.

Rural areas are also more likely to be food deserts, resulting in a lack of fruits, vegetables, and fiber-rich foods shown to lower obesity and colon cancer risk.

The study analyzed 2006 to 2015 cancer incidence data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.

The team tracked rates and deaths from colorectal cancer in 58,200 patients between ages 20 to 49.

About 43 percent of patients were ages 40 to 49, and 53 percent were male.

Additionally, one in five lived in rural areas with persistent poverty, according to USDA data, putting them at risk of developing the disease or not catching it early.

The team found that, overall, the five-year survival rate of colorectal cancer in young patients was highest for those in urban, non-impoverished areas, at 72 percent.

Meanwhile, the rate in rural and urban, impoverished areas dropped to 67 percent.

And for the youngest group of patients, ages 20 to 29, in rural, poverty-stricken areas, the survival rate dropped to 64 percent.

The researchers found that, overall, young patients with colorectal cancer 'who lived in rural areas alone had a 1.1-fold to 1.4-fold increased risk of CRC death compared to those living in nonrural areas.'

And patients living in both rural and impoverished areas were up to one and a half times more likely to die from colorectal cancer than their urban counterparts.

Though the researchers did not name specific locations, federal data sheds light on the areas at the greatest risk.

Based on the NCI's latest county-by-county data, Union County, Florida, had the highest incidence of young-onset colorectal cancer, with 32 cases per 100,000 residents under 50.

The rural county, southwest of Jacksonville, also topped the rankings for most young-onset cancers overall in a separate analysis.

The rural area with just 15,000 residents has also historically led the country in lung, oral, and skin cancers.

Health officials believe this could be due to high smoking rates and a lack of health care funding in the area, as well as one in six residents living in poverty.

USDA data shows the average household income in the area is about $55,000, about a quarter below the national average of $75,000.

The county's life expectancy is also just 67 years, well below the national average of 76.

Ouachita County, Arkansas, had the second highest rate of young-onset colorectal cancer, with 25 cases per 100,000 residents. The southwestern county has just 22,000 residents, and according to USDA data, its average household income is about $44,000, roughly 40 percent below the national average.

Mingo County, West Virginia, also had 25 cases per 100,000 people. Also housing about 22,000 residents, the area's household income is about $35,000, less than half the national average.

In terms of state data, West Virginia also led the nation in young-onset colorectal cancer, with 11 per 100,000 people.

Experts have suggested the Mountain State's high rates could be a product of high obesity prevalence, as obesity can create excess inflammation that leads to cancer cell growth.

West Virginia also has the country's highest smoking rate, a known risk factor for colorectal cancer due to it disrupting the gut microbiome.

Arlington County, Virginia, had the lowest number of young-onset colorectal cancer with 4.9 cases per 100,000 people. According to the USDA data, the household income in the urban area is $128,000, nearly 40 percent above the national average.