Background <p>Colorectal cancer (CRC) oncologic emergency presentations are associated with poor prognosis and place a significant burden on health care resources. While tumor and biological patient factors have been reported as risk factors, social determinants have not been thoroughly examined. This study aimed to examine the frequency of CRC oncologic emergencies and its association with neighborhood deprivation.</p> Methods <p>We used the Diagnosis Procedure Combination (DPC) database, a nationwide administrative dataset in Japan, for patients diagnosed with CRC receiving specific treatment for the 2014–2019 fiscal years. Neighborhood deprivation was assessed by linking patient residential postcodes and area deprivation index (ADI). We used a multilevel logistic regression model to compare the likelihood of oncologic emergencies across different degrees of ADI and examined effect modification by sex through age-stratified analysis to consider differences in social structures.</p> Results <p>Of 488,841 eligible CRC patients, 56,311 (11.5%) had experienced an oncologic emergency. We identified a disparity: the higher the degree of ADI, the greater the likelihood of oncologic emergencies (odds ratio for most vs. least deprived area 1.19; 95% confidence interval 1.15–1.23). This disparity was more pronounced in males than in females, but was observed only among middle-aged males, among whom regular employment was most common. Conclusion: The likelihood of oncologic emergencies was higher in the neighborhoods with higher deprivation levels. The magnitude of this disparity differed by sex and was particularly pronounced among those of working age, underscoring the need to further explore how socioeconomic factors—such as access to workplace cancer screening—shape these differences.</p>