Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
Cancer. 2013 Mar 1;119(5):1050-7. doi: 10.1002/cncr.27840. Epub 2012 Oct 23.
Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors.
The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics.
Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03).
The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being.
尽管农村居民更有可能被诊断出晚期癌症并死于癌症，但对于癌症幸存者自我报告的健康方面的城乡差异知之甚少。
作者从国家健康访谈调查（2006-2010 年）中确定了有自我报告癌症病史的成年人。农村-城市居住的定义使用了美国人口普查的定义。使用加权逻辑回归来评估在考虑人口统计学特征差异后，健康状况的城乡差异。
在所确定的 7804 名癌症幸存者中，有 20.8%是农村居民。这意味着美国有 280 万农村癌症幸存者。农村幸存者比城市幸存者更有可能是非西班牙裔白人（P <.001），受教育程度较低（P <.001），并且缺乏医疗保险（P <.001）。农村幸存者在所有领域的健康状况都较差。在调整了性别、种族/族裔、年龄、婚姻状况、教育程度、保险、诊断后时间和癌症数量后，农村幸存者更有可能报告健康状况不佳/较差（优势比，1.39；95%置信区间，1.20-1.62）、心理困扰（优势比，1.23；95%置信区间，1.00-1.50）、≥2 种非癌症合并症（优势比，1.15；95%置信区间，1.01-1.32）和与健康相关的失业（优势比，1.66；95%置信区间，1.35-2.03）。
目前的结果提供了美国成年癌症幸存者居住在农村地区的比例和数量的首次估计。即使在癌症诊断多年后，农村癌症幸存者也面临着各种健康不良后果的更大风险，应成为改善其健康和福祉的干预措施的目标。
