Oh Debora L, Wang Katarina, Goldberg Debbie, Schumacher Karen, Yang Juan, Lin Katherine, Gomez Scarlett Lin, Shariff-Marco Salma
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California.
Cancer Epidemiol Biomarkers Prev. 2024 Nov 1;33(11):1523-1531. doi: 10.1158/1055-9965.EPI-24-0564.
Cancer rates in rural areas vary by insurance status, socioeconomic status, region, race, and ethnicity.
California Cancer Registry data (2015-2019) were used to investigate the stage of diagnosis by levels of rurality for the five most common cancers. The percentage of residents in rural blocks within census tract aggregation zones was categorized into deciles up to 50%. Multivariable logistic regression was used to estimate associations with rurality, with separate models by cancer site, sex, race, and ethnicity (non-Hispanic White and Hispanic). Covariates included individual-level and zone-level factors.
The percentage of late-stage cancer diagnosis was 28% for female breast, 27% for male prostate, 77% for male lung, 71% for female lung, 60% for male colorectal, 59% for female colorectal, 7.8% for male melanoma, and 5.9% for female melanoma. Increasing rurality was significantly associated with increased odds of late-stage cancer diagnosis for female breast cancer (Ptrend < 0.001), male lung cancer (Ptrend < 0.001), female lung cancer (Ptrend < 0.001), and male melanoma (Ptrend = 0.01), after adjusting for individual-level and zone-level factors. The strength of associations varied by sex and ethnicity. For males with lung cancer, odds of late-stage diagnosis in areas with >50% rural population was 1.24 (95% confidence interval, 1.06-1.45) for non-Hispanic White patients and 2.14 (95% confidence interval, 0.86-5.31) for Hispanic patients, compared with areas with 0% rural residents.
Increasing rurality was associated with increased odds for late-stage diagnosis for breast cancer, lung cancer, and melanoma, with the strength of associations varying across sex and ethnicity.
Our findings will inform cancer outreach to these rural subpopulations.
农村地区的癌症发病率因保险状况、社会经济地位、地区、种族和族裔而异。
利用加利福尼亚癌症登记处的数据（2015 - 2019年），按农村程度水平调查五种最常见癌症的诊断阶段。人口普查区聚集区内农村街区居民的百分比被分为十分位数，最高为50%。采用多变量逻辑回归来估计与农村程度的关联，针对不同癌症部位、性别、种族和族裔（非西班牙裔白人和西班牙裔）建立单独模型。协变量包括个体层面和区域层面的因素。
女性乳腺癌晚期诊断的百分比为28%，男性前列腺癌为27%，男性肺癌为77%，女性肺癌为71%，男性结直肠癌为60%，女性结直肠癌为59%，男性黑色素瘤为7.8%，女性黑色素瘤为5.9%。在调整个体层面和区域层面因素后，农村程度增加与女性乳腺癌（Ptrend < 0.001）、男性肺癌（Ptrend < 0.001）、女性肺癌（Ptrend < 0.001）和男性黑色素瘤（Ptrend = 0.01）晚期癌症诊断几率增加显著相关。关联强度因性别和族裔而异。对于患有肺癌的男性，与农村居民比例为0%的地区相比，农村人口比例>50%地区的非西班牙裔白人患者晚期诊断几率为1.24（95%置信区间，1.06 - 1.45），西班牙裔患者为2.14（95%置信区间，0.86 - 5.31）。
农村程度增加与乳腺癌、肺癌和黑色素瘤晚期诊断几率增加相关，关联强度因性别和族裔而异。
我们的研究结果将为针对这些农村亚人群的癌症宣传工作提供信息。
