Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, Scotland, United Kingdom.
Western General Hospital, EH42XU Edinburgh, Scotland, United Kingdom.
Health Place. 2018 Sep;53:219-227. doi: 10.1016/j.healthplace.2018.08.010. Epub 2018 Sep 5.
Existing research from several countries has suggested that rural-dwellers may have poorer cancer survival than urban-dwellers. However, to date, the global literature has not been systematically reviewed to determine whether a rural cancer survival disadvantage is a global phenomenon.
Medline, CINAHL, and EMBASE were searched for studies comparing rural and urban cancer survival. At least two authors independently screened and selected studies. We included epidemiological studies comparing cancer survival between urban and rural residents (however defined) that also took socioeconomic status into account. A meta-analysis was conducted using 11 studies with binary rural:urban classifications to determine the magnitude and direction of the association between rurality and differences in cancer survival. The mechanisms for urban-rural cancer survival differences reported were narratively synthesised in all 39 studies.
39 studies were included in this review. All were retrospective observational studies conducted in developed countries. Rural-dwellers were significantly more likely to die when they developed cancer compared to urban-dwellers (HR 1.05 (95% CI 1.02 - 1.07). Potential mechanisms were aggregated into an ecological model under the following themes: Patient Level Characteristics; Institutions; Community, Culture and Environment; Policy and Service Organization.
Rural residents were 5% less likely to survive cancer. This effect was consistently observed across studies conducted in various geographical regions and using multiple definitions of rurality. High quality mixed-methods research is required to comprehensively evaluate the underlying factors. We have proposed an ecological model to provide a coherent framework for future explanatory research.
None.
来自多个国家的现有研究表明，农村居民的癌症生存率可能低于城市居民。然而，迄今为止，全球文献尚未进行系统审查，以确定农村地区癌症生存率较差是否是一种全球现象。
在 Medline、CINAHL 和 EMBASE 中搜索比较农村和城市癌症生存率的研究。至少有两名作者独立筛选和选择研究。我们纳入了比较城乡居民（无论如何定义）癌症生存率的流行病学研究，同时也考虑了社会经济地位。使用具有城乡二元分类的 11 项研究进行荟萃分析，以确定城乡之间癌症生存率差异的关联程度和方向。在所有 39 项研究中，对报告的城乡癌症生存率差异的机制进行了叙述性综合。
本综述纳入了 39 项研究。所有研究均为在发达国家进行的回顾性观察性研究。与城市居民相比，农村居民在罹患癌症时更有可能死亡（HR 1.05（95%CI 1.02-1.07）。潜在机制被归纳为以下主题的生态模型：患者水平特征；机构；社区、文化和环境；政策和服务组织。
农村居民患癌症的生存率低 5%。这一效应在不同地理区域和使用多种农村定义进行的研究中均得到一致观察。需要进行高质量的混合方法研究，以全面评估潜在因素。我们提出了一个生态模型，为未来的解释性研究提供一个连贯的框架。
无。
