Rural vs urban colorectal and lung cancer patients: Differences in stage at presentation
ABSTRACT Rural surgeons are often uneasy when their outcomes are compared with those of urban surgeons because they perceive that rural patients typically present with worse disease. Rural patients with cancer are commonly thought to present at a later stage of disease, although this is based largely on anecdotal evidence.
Retrospective, descriptive analysis of cancer stage at presentation of rural versus urban patients with two common cancers (lung, colorectal) using the Surveillance, Epidemiology, and End Results database from the National Cancer Institute. Rural versus urban designations were based on rural-urban continuum codes from the US Department of Agriculture. We constructed an ordinal logistic regression model to compare stage at presentation between rural and urban colorectal and lung cancer patients, while controlling for other factors that might be associated with late stage at presentation, including age, race, gender, marital status, income level, and level of education.
In univariate and multivariate analyses, patients with colorectal and lung cancer from rural areas were not more likely to present at later stage. The ordinal logistic regression model indicated that urban patients are more likely to present with late-stage colorectal and lung cancer, compared with rural patients (p < 0.001). For colon cancer, other factors notably associated with stage IV disease were low-income, African-American race, age younger than 65 years, divorce, male gender, and language isolation. For lung cancer, factors notably associated with stage IV disease were African-American race, divorce, male gender, and language isolation.
Urban rather than rural residence appears to be associated with later stages of lung and colorectal cancer at presentation. This finding is contrary to the common assumption that rural patients present at later stages of disease.
SourceAvailable from: Peter Murchie[Show abstract] [Hide abstract]
ABSTRACT: Background Rural residence may adversely affect cancer outcomes, perhaps because rural cancer patients are managed differently. Current UK guidelines recommend all patients with suspected melanoma be referred urgently for specialist excision biopsy; however, up to 20% of patients receive their biopsy in primary care. This project explored if rural dwellers with melanoma were more likely to have their primary biopsy in primary care.MethodsA clinical database of all primary cutaneous melanomas diagnosed in Northern Scotland between January 1991 and July 2007 was analyzed for patient demographics, clinical variables, and intermediate outcomes. Significant findings on univariate analysis were then included in a binary logistic regression model to adjust for confounders.ResultsOn univariate analysis patients living in rural areas were significantly more likely to have their melanomas excised in primary care compared with those living in the city (26.3% compared with 17.7%, P Conclusions In Northern Scotland patients living in suburban areas and remote small towns are significantly more likely to have an initial melanoma excision in primary care, contrary to current UK guidelines. This geographical contrast signposts the way to further in‐depth research into the interplay between place of residence and how the cancer journey is experienced.The Journal of Rural Health 08/2013; 29. DOI:10.1111/jrh.12011 · 1.77 Impact Factor
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ABSTRACT: Urban sprawl has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, transportation choices and other correlates of sprawl and urbanization. This paper presents a cross-sectional analysis of associations between urban sprawl and cancer mortality in urban and suburban counties of the United States. This ecological analysis was designed to examine whether urban sprawl is associated with total and obesity-related cancer mortality and to what extent these associations differed in different regions of the US. A major focus of our analyses was to adequately account for spatial heterogeneity in mortality. Therefore, we fit a series of regression models, stratified by gender, successively testing for the presence of spatial heterogeneity. Our resulting models included county level variables related to race, smoking, obesity, access to health services, insurance status, socioeconomic position, and broad geographic region as well as a measure of urban sprawl and several interactions. Our most complex models also included random effects to account for any county-level spatial autocorrelation that remained unexplained by these variables. Total cancer mortality rates were higher in less sprawling areas and contrary to our initial hypothesis; this was also true of obesity related cancers in six of seven U.S. regions (census divisions) where there were statistically significant associations between the sprawl index and mortality. We also found significant interactions (p < 0.05) between region and urban sprawl for total and obesity related cancer mortality in both sexes. Thus, the association between urban sprawl and cancer mortality differs in different regions of the US. Despite higher levels of obesity in more sprawling counties in the US, mortality from obesity related cancer was not greater in such counties. Identification of disparities in cancer mortality within and between geographic regions is an ongoing public health challenge and an opportunity for further analytical work identifying potential causes of these disparities. Future analyses of urban sprawl and health outcomes should consider exploring regional and international variation in associations between sprawl and health.International Journal of Health Geographics 01/2014; 13(1):3. DOI:10.1186/1476-072X-13-3 · 2.62 Impact Factor
Conference Paper: Urban sprawl and cancer mortality in the United States[Show abstract] [Hide abstract]
ABSTRACT: Background: Urban sprawl is a known correlate of obesity and has the potential to influence cancer mortality via direct and indirect effects on obesity, access to health services, physical activity, and transportation choices. Purpose: To examine the cross-sectional associations between cancer mortality, urban sprawl, obesity, and covariates at the county level in the United States. Methods: Data include SEER/NCI county (n = 936) cancer mortality estimates (2002-2006) for sixteen cancer sites, obesity prevalence (2007), urban sprawl index (2001), and additional covariates (2001-2006). The sprawl index was based on 22 variables grouped into four factors/dimensions of sprawl at the county level and ranged from 62 (most sprawling) to 478 (Least Sprawling). Results: Analyses of main effects indicated that cancer mortality was inversely associated with urban sprawl for liver and stomach and positively associated with sprawl for prostate, leukemia, non-Hodgkin's lymphoma, brain, melanoma, and lung, cancer in males. After adjustment for obesity, positive associations remained for brain, melanoma, lung, and liver cancer. Similar results were observed in females along with inverse associations between sprawl and cancer of the uterus. Analyses of two-way interactions suggest that some of these main effects are modified by pair-wise associations between race, availability of medical care and smoking characteristics. Conclusions: Ecological analyses of associations between urban sprawl and cancer mortality could help identify targets for public health interventions and potentially provide estimates of the potential magnitude of risk related to residence in urban vs. suburban areas.139st APHA Annual Meeting and Exposition 2011; 10/2011