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

Abstract Background Rural 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 pres...

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Autores principales:	Jeffrey A. Thompson, Lynn Chollet-Hinton, John Keighley, Audrey Chang, Dinesh Pal Mudaranthakam, David Streeter, Jinxiang Hu, Michele Park, Byron Gajewski
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cancer Rurality Healthcare disparities Socioeconomic factors Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/45a3b9e32bc84599b9cd638b162e7dfd
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spelling	oai:doaj.org-article:45a3b9e32bc84599b9cd638b162e7dfd2021-11-28T12:13:03ZThe need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri10.1186/s12889-021-12190-w1471-2458https://doaj.org/article/45a3b9e32bc84599b9cd638b162e7dfd2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12190-whttps://doaj.org/toc/1471-2458Abstract Background Rural 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. Methods We 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. Results We 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. Conclusion Many 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.Jeffrey A. ThompsonLynn Chollet-HintonJohn KeighleyAudrey ChangDinesh Pal MudaranthakamDavid StreeterJinxiang HuMichele ParkByron GajewskiBMCarticleCancerRuralityHealthcare disparitiesSocioeconomic factorsPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cancer Rurality Healthcare disparities Socioeconomic factors Public aspects of medicine RA1-1270
spellingShingle	Cancer Rurality Healthcare disparities Socioeconomic factors Public aspects of medicine RA1-1270 Jeffrey A. Thompson Lynn Chollet-Hinton John Keighley Audrey Chang Dinesh Pal Mudaranthakam David Streeter Jinxiang Hu Michele Park Byron Gajewski The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
description	Abstract Background Rural 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. Methods We 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. Results We 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. Conclusion Many 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.
format	article
author	Jeffrey A. Thompson Lynn Chollet-Hinton John Keighley Audrey Chang Dinesh Pal Mudaranthakam David Streeter Jinxiang Hu Michele Park Byron Gajewski
author_facet	Jeffrey A. Thompson Lynn Chollet-Hinton John Keighley Audrey Chang Dinesh Pal Mudaranthakam David Streeter Jinxiang Hu Michele Park Byron Gajewski
author_sort	Jeffrey A. Thompson
title	The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
title_short	The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
title_full	The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
title_fullStr	The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
title_full_unstemmed	The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri
title_sort	need to study rural cancer outcome disparities at the local level: a retrospective cohort study in kansas and missouri
publisher	BMC
publishDate	2021
url	https://doaj.org/article/45a3b9e32bc84599b9cd638b162e7dfd
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The need to study rural cancer outcome disparities at the local level: a retrospective cohort study in Kansas and Missouri

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