Department of Surgery, Creighton University School of Medicine, Omaha, NE, United States; Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States.
Department of Surgery, Catholic Health Initiatives Health, Omaha, NE, United States.
J Gastrointest Surg. 2024 Nov;28(11):1883-1889. doi: 10.1016/j.gassur.2024.08.011. Epub 2024 Sep 6.
Colorectal cancer (CRC) is a leading cause of death in rural America. Rural populations are large and heterogeneous, yet patient-related drivers of inequities in CRC access are understudied. This study aimed to identify vulnerable rural populations at lower odds of undergoing elective CRC surgery.
Evaluation of the Policy Map and United States Census Bureau identified factors associated with poor surgical access in the most populous states (by total rural population). To assess whether these identified factors were associated with reduced access to elective CRC surgery, the 2007 to 2020 National Inpatient Sample was used to evaluate 69,212 hospitalizations of rural patients undergoing CRC surgery. Rural was defined as counties with a population of <250,000. Multivariable logistic regression models assessed predictors of elective CRC surgery. Patient- and hospital-level factor interactions were specified a priori.
More than 72% of hospitalizations of rural patients were elective. Multivariate regression analysis demonstrated that older age, multimorbidity, Black race, Latino-Hispanic ethnicity, Medicaid insurance, and rural hospitals predicted lower odds of elective CRC surgery. On interaction analyses, high-risk patients were less likely to undergo elective CRC surgery in urban facilities relative to rural.
In this large study of rural dwellers, ethnoracial minorities, elders, and Medicaid beneficiaries had profoundly less access to elective CRC surgery, especially when care was received in urban settings. Future studies should focus on exploring actionable social drivers of health in these rural populations. Findings underscore the need for multilevel interventions to enhance rural access to equitable and quality surgical cancer care.
结直肠癌（CRC）是美国农村地区的主要死亡原因。农村人口众多且异质，但患者相关因素导致 CRC 治疗机会不平等的研究却很少。本研究旨在确定接受择期 CRC 手术可能性较低的脆弱农村人群。
评估政策地图和美国人口普查局确定了人口最多的州（按农村总人口计算）中与手术机会不良相关的因素。为了评估这些确定的因素是否与接受择期 CRC 手术的机会减少有关，使用 2007 年至 2020 年国家住院患者样本评估了 69212 例农村 CRC 手术患者的住院情况。农村地区的定义为人口少于 25 万的县。多变量逻辑回归模型评估了择期 CRC 手术的预测因素。事先规定了患者和医院水平因素的相互作用。
超过 72%的农村患者的住院治疗为择期。多变量回归分析表明，年龄较大、合并症较多、黑人、拉丁裔/西班牙裔、医疗补助保险和农村医院与择期 CRC 手术的可能性较低相关。在交互分析中，与农村设施相比，高危患者在城市设施中接受择期 CRC 手术的可能性较低。
在这项针对农村居民的大型研究中，少数民族、老年人和医疗补助受益人的 CRC 手术机会明显较少，尤其是在城市医疗机构接受治疗时。未来的研究应重点探讨这些农村人群中可采取行动的健康社会驱动因素。研究结果强调需要采取多层次干预措施，以增强农村地区获得公平和高质量的手术癌症护理的机会。
