Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine.
Department of Medicine, Maine Medical Center, Portland, Maine.
J Rural Health. 2019 Sep;35(4):560-565. doi: 10.1111/jrh.12355. Epub 2019 Feb 19.
Lung cancer is the leading cause of cancer-related mortality in the United States, and rural states bear a greater burden of disease.
We analyzed tumor registry data to examine relationships between rurality and lung cancer stage at diagnosis and treatment. Cases were from the Maine Cancer Registry from 2012 to 2015, and rurality was defined using rural-urban commuting areas. Multivariable models were used to examine the relationships between rurality and treatment, adjusting for age, sex, poverty, education, insurance status, and cancer stage.
We identified 5,338 adults with incident lung cancer; 3,429 (64.2%) were diagnosed at a late stage (III or IV). Rurality was not associated with stage at diagnosis. For patients with early-stage disease (I or II), rurality was not associated with receipt of treatment. However, for patients with late-stage disease, residents of large rural areas received more surgery (10%) compared with metropolitan (9%) or small/isolated rural areas (6%), P = .01. In multivariable analyses, patients in large rural areas received more chemotherapy (OR 1.48; 95% CI: 1.08-2.02) than those in metropolitan areas. Patients with early-stage disease residing in small/ isolated rural areas had delays in treatment (median time to first treatment = 43 days, interquartile range [IQR] 22-68) compared with large rural (34 days, IQR 17-55) and metropolitan areas (35 days, IQR 17-60), P = .0009.
Rurality is associated with differences in receipt of specific lung cancer treatments and in timeliness of treatment.
肺癌是美国癌症相关死亡的主要原因，农村州的疾病负担更大。
我们分析了肿瘤登记数据，以研究农村地区与诊断和治疗时的肺癌分期之间的关系。病例来自 2012 年至 2015 年的缅因州癌症登记处，农村地区的定义是使用城乡通勤区。多变量模型用于研究农村地区与治疗之间的关系，调整了年龄、性别、贫困、教育、保险状况和癌症分期。
我们确定了 5338 名患有肺癌的成年人；3429 名（64.2%）被诊断为晚期（III 或 IV 期）。农村地区与诊断时的分期无关。对于早期疾病（I 期或 II 期）患者，农村地区与治疗的接受无关。然而，对于晚期疾病患者，大农村地区的居民接受了更多的手术（10%），而大都市地区（9%）或小/孤立农村地区（6%），P =.01。在多变量分析中，大农村地区的患者接受了更多的化疗（OR 1.48；95%CI：1.08-2.02）比大都市地区的患者。小/孤立农村地区的早期疾病患者的治疗延迟（中位数治疗时间=43 天，四分位间距[IQR]22-68）与大农村（34 天，IQR 17-55）和大都市地区（35 天，IQR 17-60）相比，P =.0009。
农村地区与特定肺癌治疗的接受情况以及治疗及时性的差异有关。
