Division of Pulmonary-Critical Care Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Veterans Rural Health Resource Center-Iowa City, Veterans Health Administration (VHA), Office of Rural Health, and the Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VHA, Iowa City, Iowa.
J Rural Health. 2020 Sep;36(4):484-495. doi: 10.1111/jrh.12429. Epub 2020 May 30.
To evaluate the association between rurality and lung cancer stage at diagnosis.
We conducted a cross-sectional study using Veterans Health Administration (VHA) data to identify veterans newly diagnosed with lung cancer between October 1, 2011 and September 30, 2015. We defined rurality, based on place of residence, using Rural-Urban Commuting Area (RUCA) codes with the subcategories of urban, large rural, small rural, and isolated. We used multivariable logistic regression models to determine associations between rurality and stage at diagnosis, adjusting for sociodemographic and clinical characteristics. We also analyzed data using the RUCA code for patients' assigned primary care sites and driving distances to primary care clinics and medical centers.
We identified 4,220 veterans with small cell lung cancer (SCLC) and 25,978 with non-small cell lung cancer (NSCLC). Large rural residence (compared to urban) was associated with early-stage diagnosis of NSCLC (OR = 1.12; 95% CI: 1.00-1.24) and SCLC (OR = 1.73; 95% CI: 1.18-1.55). However, the finding was significant only in the southern and western regions of the country. White race, female sex, chronic lung disease, higher comorbidity, receiving primary care, being a former tobacco user, and more recent year of diagnosis were also associated with diagnosing early-stage NSCLC. Driving distance to medical centers was inversely associated with late-stage NSCLC diagnoses, particularly for large rural areas.
We did not find clear associations between rurality and lung cancer stage at diagnosis. These findings highlight the complex relationship between rurality and lung cancer within VHA, suggesting access to care cannot be fully captured by current rurality codes.
评估诊断时的农村与肺癌分期之间的关联。
我们使用退伍军人健康管理局（VHA）的数据进行了一项横断面研究，以确定 2011 年 10 月 1 日至 2015 年 9 月 30 日期间新诊断出患有肺癌的退伍军人。我们根据居住地使用农村-城市通勤区（RUCA）代码来定义农村地区，RUCA 代码的亚类包括城市、大农村、小农村和孤立地区。我们使用多变量逻辑回归模型来确定农村与诊断时分期之间的关联，同时调整了社会人口统计学和临床特征。我们还使用患者指定的初级保健站点和到初级保健诊所和医疗中心的驾驶距离的 RUCA 代码分析数据。
我们确定了 4220 例小细胞肺癌（SCLC）和 25978 例非小细胞肺癌（NSCLC）患者。与城市相比，大农村地区居住与 NSCLC（OR=1.12；95%CI：1.00-1.24）和 SCLC（OR=1.73；95%CI：1.18-1.55）的早期诊断相关。然而，这一发现仅在该国的南部和西部地区具有统计学意义。白人种族、女性、慢性肺部疾病、更高的合并症、接受初级保健、曾经是烟草使用者以及更近期的诊断年份也与早期诊断 NSCLC 相关。到医疗中心的驾驶距离与晚期 NSCLC 诊断呈负相关，尤其是在大农村地区。
我们没有发现农村与诊断时肺癌分期之间存在明确的关联。这些发现突显了 VHA 内农村与肺癌之间复杂的关系，表明目前的农村分类法无法完全反映医疗保健的可及性。
