The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri

BMC Public Health

John Keighley¹  Byron Gajewski²  Jeffrey A. Thompson²  Dinesh Pal Mudaranthakam²  Jinxiang Hu²  David Streeter²  Lynn Chollet-Hinton²  Audrey Chang³  Michele Park⁴ 

[1] Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160, Kansas City, KS, USA;Department of Biostatistics & Data Science, University of Kansas Medical Center, Mail Stop 1026, 3901 Rainbow Blvd, 66160, Kansas City, KS, USA;University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, 66160, Kansas City, KS, USA;Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, 30322, Atlanta, GA, USA;University of Kansas Cancer Center, University of Kansas Medical Center, 3901 Rainbow Blvd, 66160, Kansas City, KS, USA;

关键词: Cancer;    Rurality;    Healthcare disparities;    Socioeconomic factors;   

DOI  :  10.1186/s12889-021-12190-w

来源: Springer

【 摘 要 】

BackgroundRural residence is commonly thought to be a risk factor for poor cancer outcomes. However, a number of studies have reported seemingly conflicting information regarding cancer outcome disparities with respect to rural residence, with some suggesting that the disparity is not present and others providing inconsistent evidence that either urban or rural residence is associated with poorer outcomes. We suggest a simple explanation for these seeming contradictions: namely that rural cancer outcome disparities are related to factors that occur differentially at a local level, such as environmental exposures, lack of access to care or screening, and socioeconomic factors, which differ by type of cancer.MethodsWe conducted a retrospective cohort study examining ten cancers treated at the University of Kansas Medical Center from 2011 to 2018, with individuals from either rural or urban residences. We defined urban residences as those in a county with a U.S. Department of Agriculture Urban Influence Code (UIC) of 1 or 2, with all other residences defines a rural. Inverse probability of treatment weighting was used to create a pseudo-sample balanced for covariates deemed likely to affect the outcomes modeled with cumulative link and weighted Cox-proportional hazards models.ResultsWe found that rural residence is not a simple risk factor but rather appears to play a complex role in cancer outcome disparities. Specifically, rural residence is associated with higher stage at diagnosis and increased survival hazards for colon cancer but decreased risk for lung cancer compared to urban residence.ConclusionMany cancers are affected by unique social and environmental factors that may vary between rural and urban residents, such as access to care, diet, and lifestyle. Our results show that rurality can increase or decrease risk, depending on cancer site, which suggests the need to consider the factors connected to rurality that influence this complex pattern. Thus, we argue that such disparities must be studied at the local level to identify and design appropriate interventions to improve cancer outcomes.

【 授权许可】

CC BY