California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, UC Davis Comprehensive Cancer Center, UC Davis Health, Sacramento, California.
California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, UC Davis Comprehensive Cancer Center, UC Davis Health, Sacramento, California.
Am J Prev Med. 2021 Dec;61(6):e279-e288. doi: 10.1016/j.amepre.2021.05.021. Epub 2021 Aug 14.
Previous research suggests cancer patients living in rural areas have lower quality of care, but population-based studies have yielded inconsistent results. This study examines the impact of rurality on care quality for 7 cancer types in California.
Breast, ovarian, endometrial, cervix, colon, lung, and gastric cancer patients diagnosed from 2004 to 2017 were identified in the California Cancer Registry. Multivariable logistic regression and proportional hazards models were used to assess effects of residential location on quality of care and survival. Stratified models examined the impact of treatment at National Cancer Institute designated cancer centers (NCICCs). Quality of care was evaluated using Commission on Cancer measures. Medical Service Study Areas were used to assess urban/rural status. Data were collected in 2004-2019 and analyzed in 2020.
989,747 cancer patients were evaluated, with 14% living in rural areas. Rural patients had lower odds of receiving radiation after breast conserving surgery compared to urban residents. Colon and gastric cancer patients had 20% and 16% lower odds, respectively, of having optimal surgery. Rural patients treated at NCICCs had greater odds of recommended surgery for most cancer types. Survival was similar among urban and rural subgroups.
Rural residence was inversely associated with receipt of recommended surgery for gastric and colon cancer patients not treated at NCICCs, and for receiving recommended radiotherapy after breast conserving surgery regardless of treatment location. Further studies investigating the impact of care location and availability of supportive services on urban-rural differences in quality of care are warranted.
先前的研究表明，农村地区的癌症患者的医疗质量较低，但基于人群的研究结果并不一致。本研究调查了加利福尼亚州 7 种癌症类型的农村人口对护理质量的影响。
在加利福尼亚癌症登记处确定了 2004 年至 2017 年期间诊断出的乳腺癌、卵巢癌、子宫内膜癌、宫颈癌、结肠癌、肺癌和胃癌患者。多变量逻辑回归和比例风险模型用于评估居住地点对护理质量和生存的影响。分层模型检查了在国家癌症研究所指定的癌症中心（NCICCs）进行治疗的影响。使用肿瘤委员会（Commission on Cancer）的措施评估护理质量。使用医学服务研究区（Medical Service Study Areas）来评估城市/农村状况。数据收集于 2004 年至 2019 年，并于 2020 年进行分析。
共评估了 989747 例癌症患者，其中 14%居住在农村地区。与城市居民相比，农村患者接受保乳手术后接受放疗的可能性较低。结肠和胃癌患者接受最佳手术的可能性分别降低了 20%和 16%。在 NCICCs 接受治疗的农村患者，大多数癌症类型接受推荐手术的可能性更大。城市和农村亚组的生存率相似。
农村居住地与未在 NCICCs 接受治疗的结肠和胃癌患者接受推荐手术的可能性降低以及接受保乳手术后接受推荐放疗的可能性降低呈负相关，而无论治疗地点如何，农村患者接受推荐手术的可能性更高。需要进一步研究护理地点和支持服务的可用性对城乡医疗质量差异的影响。
