患者居住在农村地区是否预示着结肠癌的优质护理？一项基于人群的研究。
Does patient rurality predict quality colon cancer care?: A population-based study.
作者信息
Chow Christopher J, Al-Refaie Waddah B, Abraham Anasooya, Markin Abraham, Zhong Wei, Rothenberger David A, Kwaan Mary R, Habermann Elizabeth B
机构信息
1 Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2 Department of Surgery, Georgetown University Hospital and Lombardi Comprehensive Cancer, Washington, District of Columbia 3 Genentech, South San Francisco, California 4 Division of Health Care Policy and Research and Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
出版信息
Dis Colon Rectum. 2015 Apr;58(4):415-22. doi: 10.1097/DCR.0000000000000173.
BACKGROUND
More than 50 million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening.
OBJECTIVE
Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care.
DESIGN
We constructed a retrospective cohort of 123,129 patients with stage 0 to IV colon cancer. Rural residence was established based on the patient medical service study area designated by the registry.
SETTINGS
The study was conducted using the 1996-2008 California Cancer Registry.
PATIENTS
All of the patients diagnosed between 1996 and 2008 with tumors located in the colon were eligible for inclusion in this study.
MAIN OUTCOME MEASURES
Baseline characteristics were compared by rurality status. Multivariate regression models then were used to examine the impact of rurality on stage in the entire cohort, adequate lymphadenectomy in stage I to III disease, and receipt of chemotherapy for stage III disease. Proportional-hazards regression was used to examine the impact of rurality on cancer-specific survival.
RESULTS
Of all of the patients diagnosed with colon cancer, 18,735 (15%) resided in rural areas. Our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy in stage I to III disease, and lower likelihood of receiving chemotherapy for stage III disease. In addition, rurality was associated with worse cancer-specific survival.
LIMITATIONS
We could not account for socioeconomic status directly, although we used insurance status as a surrogate. Furthermore, we did not have access to treatment location or distance traveled. We also could not account for provider or hospital case volume, patient comorbidities, or complications.
CONCLUSIONS
A significant portion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with modest differences in stage, adherence to quality measures, and survival. Future endeavors should help improve care to this vulnerable population (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A143).
背景
超过5000万人居住在美国农村地区。然而，尽管患者居住在农村对结肠癌筛查有已知影响，但患者居住在农村对结肠癌治疗的影响尚未得到充分描述。
目的
我们的研究旨在探讨患者居住在农村对结肠癌优质综合治疗的影响。
设计
我们构建了一个包含123129例0至IV期结肠癌患者的回顾性队列。根据登记处指定的患者医疗服务研究区域确定农村居住地。
背景
该研究使用1996 - 2008年加利福尼亚癌症登记处的数据进行。
患者
所有在1996年至2008年间被诊断出肿瘤位于结肠的患者均符合纳入本研究的条件。
主要观察指标
按农村居住状况比较基线特征。然后使用多变量回归模型来研究农村居住状况对整个队列分期、I至III期疾病充分淋巴结清扫以及III期疾病接受化疗的影响。使用比例风险回归来研究农村居住状况对癌症特异性生存的影响。
结果
在所有被诊断为结肠癌的患者中，18735例（15%）居住在农村地区。我们的多变量模型表明，居住在农村与诊断分期较晚、I至III期疾病淋巴结清扫不充分以及III期疾病接受化疗的可能性较低有关。此外，居住在农村与较差的癌症特异性生存相关。
局限性
尽管我们使用保险状况作为替代指标，但我们无法直接考虑社会经济地位。此外，我们无法获取治疗地点或出行距离。我们也无法考虑医疗服务提供者或医院的病例数量、患者合并症或并发症。
结论
接受结肠癌治疗的患者中有很大一部分生活在农村地区。然而，居住在农村与分期、对质量指标的依从性和生存方面的适度差异有关。未来的努力应有助于改善对这一弱势群体的治疗（见视频，补充数字内容1，http://links.lww.com/DCR/A143）。
Zotero 插件