Department of Neurosurgery, University of California, San Diego, La Jolla, USA.
Department of Neurosurgery, UC San Diego Health, 9300 Campus Point Drive, MC7893, La Jolla, CA, 92037, USA.
J Neurooncol. 2019 Sep;144(3):535-543. doi: 10.1007/s11060-019-03254-4. Epub 2019 Aug 5.
Rural/urban disparities in brain cancer survival have been reported. However, disparities by cancer type or in the United States as a whole remain poorly understood. Using the Surveillance, Epidemiology, and End Results (SEER) 18 registries database, we examined brain cancer survival by rural/urban residence defined by Rural-Urban Continuum Codes (RUCCs).
We obtained data from SEER 18 registries for individuals aged 20 years and older with a first primary malignant brain cancer from 2001 to 2011. Rural/urban residence at diagnosis was defined using both metropolitan/non-metropolitan county classifications and individual RUCC categories. We used Cox proportional hazards regression to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between rural/urban residence and brain cancer survival.
Among 37,581 cancer cases, 77.9% were non-Hispanic White, 56.5% were male, and 88.7% lived in a metropolitan county. Brain cancer patients living in the most rural counties had a significant increased risk of cancer death compared to those living in the most urban counties (HR 1.15; 95% CI 1.01-1.31). Those living in non-metropolitan counties had a similar risk of cancer death compared to those living in metropolitan counties (HR 1.01; 95% CI 0.97-1.06). Effect modification was observed overall by cancer type, with non-specified oligodendroglioma (HR 1.35; 95% CI 1.01-1.81) showing the greatest effect.
After adjusting for confounding factors, our results suggest that rural residence has a modest effect on brain cancer survival, and that this disparity may vary by cancer type. Future research should explore differences in treatment strategies between rural and urban brain cancer patients.
已有报道称，脑癌的城乡存活率存在差异。然而，对于不同癌症类型或全美范围内的差异，我们仍知之甚少。本研究使用监测、流行病学和最终结果（SEER）18 个登记数据库，根据农村-城市连续统一体代码（RUCC）来研究脑癌的城乡生存情况。
我们从 SEER 18 个登记处获取了 2001 年至 2011 年间年龄在 20 岁及以上的首位原发性恶性脑癌患者的数据。使用大都市/非大都市县分类和个人 RUCC 类别来定义诊断时的城乡居住情况。我们使用 Cox 比例风险回归来计算城乡居住与脑癌生存之间关联的调整后风险比（HR）和 95%置信区间（CI）。
在 37581 例癌症病例中，77.9%为非西班牙裔白人，56.5%为男性，88.7%居住在大都市县。与居住在最城市县的患者相比，居住在最农村县的脑癌患者癌症死亡风险显著增加（HR 1.15；95%CI 1.01-1.31）。与居住在大都市县的患者相比，居住在非大都市县的患者癌症死亡风险相似（HR 1.01；95%CI 0.97-1.06）。整体上观察到癌症类型存在效应修饰，未特指的少突胶质细胞瘤（HR 1.35；95%CI 1.01-1.81）的影响最大。
在调整了混杂因素后，我们的结果表明，农村居住对脑癌的生存有一定影响，而且这种差异可能因癌症类型而异。未来的研究应探讨农村和城市脑癌患者之间治疗策略的差异。
