Department of Medical Social Science, Center for Community Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Division of Research, Kaiser Permanente, Northern California, Oakland, California.
JAMA Netw Open. 2022 May 2;5(5):e2212246. doi: 10.1001/jamanetworkopen.2022.12246.
Considering reported rural-urban cancer incidence and mortality trends, rural-urban cancer survival trends are important for providing a comprehensive description of cancer burden. Furthermore, little is known about rural-urban differences in survival trends by racial and ethnic groups.
To examine national rural-urban trends in 5-year cancer-specific survival probabilities for lung, prostate, breast, and colorectal cancers in a diverse sample of racial and ethnic groups.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used an epidemiologic assessment with 1975 to 2016 Surveillance, Epidemiology, and End Results (SEER) data to analyze patients diagnosed no later than 2011. Patients were classified as living in rural and urban counties based on the 2013 Rural-Urban Continuum Codes.
The 5-year cancer-specific survival probability of urban and rural patients for each cancer type was estimated by fitting Cox proportional hazard regression models accounting for race, ethnicity, tumor characteristics, and other sociodemographic characteristics. A generalized linear regression model was used to estimate the mean estimated probability of survival for each stratum. Joinpoint regression analysis estimated periods of significant change in survival.
In this study, data from 3 659 417 patients with cancer (median [IQR] age, 67 [58-76]; 1 918 609 [52.4%] male; 237 815 [6.5%] Hispanic patients; 396 790 [10.8%] Black patients; 2 825 037 [77.2%] White patients) were analyzed, including 888 338 patients with lung cancer (24.3%), 750 704 patients with colorectal cancer (20.5%), 987 826 patients with breast cancer (27.0%) breast, and 1 023 549 patients with prostate cancer (28.0%). There were 430 353 rural patients (11.8%). Overall, there was an equal representation of rural and urban men. Rural patients were likely to be non-Hispanic White individuals, have more cases of distant tumors, and be older. Rural and non-Hispanic Black patients for all cancer types often had shorter survival. From 1975 to 2016, the 5-year lung cancer survival rate was shorter for non-Hispanic Black rural patients in 1975 at 48%, while increasing to 57% for both non-Hispanic Black urban and rural patients in 2011, but still the shortest among all cancer types. In 1975, the longest survival rate was observed in urban Asian and Pacific Islander patients with breast cancer at 86%, and in 2011, the longest survival rate was observed in urban non-Hispanic White patients with XX cancer at 92%.
Even after accounting for sociodemographic and tumor characteristics, these findings suggest that non-Hispanic Black patients with cancer are particularly vulnerable to cancer burden, and resources are urgently needed to reverse decades-old survival trends.
考虑到报告的城乡癌症发病率和死亡率趋势，城乡癌症生存趋势对于全面描述癌症负担非常重要。此外，关于不同种族和族裔群体的生存趋势的城乡差异知之甚少。
在一个多样化的种族和族裔群体中，检查肺癌、前列腺癌、乳腺癌和结直肠癌的 5 年癌症特异性生存率的全国城乡趋势。
设计、设置和参与者：这项横断面研究使用流行病学评估方法，结合 1975 年至 2016 年的监测、流行病学和最终结果 (SEER) 数据，分析了截至 2011 年确诊的患者。根据 2013 年城乡连续体代码，将患者分类为居住在农村和城市县。
通过拟合 Cox 比例风险回归模型，考虑种族、族裔、肿瘤特征和其他社会人口统计学特征，估计了每一种癌症类型的城乡患者的 5 年癌症特异性生存率。使用广义线性回归模型估计每个分层的平均估计生存率。连接点回归分析估计了生存率变化的显著时期。
在这项研究中，分析了 3659417 名癌症患者的数据（中位数[IQR]年龄，67 [58-76]；1918609 [52.4%]男性；237815 [6.5%]西班牙裔患者；396790 [10.8%]黑人患者；2825037 [77.2%]白人患者），包括 888338 名肺癌患者（24.3%）、750704 名结直肠癌患者（20.5%）、987826 名乳腺癌患者（27.0%）和 1023549 名前列腺癌患者（28.0%）。有 430353 名农村患者（11.8%）。总体而言，城乡男性的比例相当。农村患者可能是非西班牙裔白人，有更多的远处肿瘤病例，年龄更大。农村和非西班牙裔黑人患者的所有癌症类型的生存率往往较短。从 1975 年到 2016 年，1975 年非西班牙裔黑人农村患者的 5 年肺癌生存率为 48%，而 2011 年非西班牙裔黑人城乡患者的生存率均上升至 57%，但仍是所有癌症类型中最短的。1975 年，城市亚裔和太平洋岛民乳腺癌患者的最长生存率为 86%，而 2011 年，城市非西班牙裔白人 XX 癌患者的最长生存率为 92%。
即使考虑了社会人口统计学和肿瘤特征，这些发现表明，癌症患者中的非西班牙裔黑人特别容易受到癌症负担的影响，迫切需要资源来扭转数十年来的生存趋势。
