Differences in survival among rural and urban lung cancer patients in Florida, 1996-2007
Methods: Florida Cancer Data System Registry (1996-2007), Agency for Health Care Administration, and US Census data were linked (n=165,465). Place of residence was defined using the Rural-Urban Community Area Codes. Descriptive demographic statistics for rural vs. urban cancer patients, and Cox regression models exploring the association of place of residence with survival were performed.
Results: Overall, 93% of patients were urban and 7% rural residents. The distribution of ethnicity differed between urban (non-Hispanic 93.6%, Hispanic 6.4%) and rural (non-Hispanic 98.4%, Hispanic 1.6%); as did the distribution of socioeconomic status (SES) from lowest to highest quartiles in urban (12.4, 30.3, 38.9, 18.4%) and rural (19.7, 61.9, 17.2, 1.2%) areas. More rural (75.4%) than urban (63.5%) patients were seen at low-volume hospitals and more had small cell lung cancer (13.4 vs. 12.4% respectively). Median survival time was shorter (6.9 months) in rural than urban (8.2 months) patients. In the multivariate model, adjusting for comorbidities, sociodemographic, clinical, and treatment characteristics, there was no difference in survival between rural and urban residents (Hazard ratio:1.00; 95%CI: 0.94-1.06]).
Conclusion: Unadjusted median survival is shorter in rural vs. urban lung cancer patients. However, this survival difference appears to be due to differences in case-mix and sociodemographic status.
Learning Areas:Chronic disease management and prevention
Diversity and culture
Explain how the Rural-Urban Community Area Codes define the distinction between rural vs. urban place of residence. Describe the differences in the populations that reside in urban and rural areas. Discuss reasons why differences urban vs. rural areas might lead to differences in receipt of health care and potentially in survival in lung cancer patients.
Qualified on the content I am responsible for because: I am qualified to be an abstract author because I have been the principal and co-principal investigator of a multiple federally funded grants focusing on the epidemiology of cancer in a population-based sample in the state of Florida. I have worked with hospital volume and teaching disparities in breast and lung cancers
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.