Onega Tracy, Ramkumar Niveditta, Brooks Gabriel A, Loehrer Andrew P, Kapadia Nirav S, O'Malley A James, Fraze Taressa K, Smith Rebecca E, Wang Qianfei, Wong Sandra L, Tosteson Anna N A
Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
J Rural Health. 2025 Mar;41(2):e12890. doi: 10.1111/jrh.12890. Epub 2024 Oct 12.
We examined the relationship between travel burden for surgical cancer care and rurality, geographic bypass of the nearest surgical facility, cancer type, and mortality outcomes.
Using Medicare claims and enrollment data (2016-2018) from beneficiaries with cancer of the colon, rectum, lung, or pancreas, we measured travel times to: the nearest surgical facility and facility used. For those who bypassed the nearest, we examined travel time and rurality in relation to surgical rates. Using multivariable regression modeling, we estimated associations of bypass with 90-day postoperative- and one-year mortality; rurality was examined as an effect modifier.
Among 211,025 beneficiaries with cancer, 25.5% resided in non-metropolitan areas. About 66% of metropolitan/micropolitan, and 78% of small town/rural patients bypassed their closest facility. Increasing rurality was significantly associated with increased likelihood of bypass (Referent = metropolitan, OR; 95%CI: micropolitan 1.10; 1.04-1.16, small town/rural 2.08; 1.96-2.20. Bypassing the nearest facility was associated with decreased likelihood of both 90-day postoperative mortality (OR = 0.79; 95%CI 0.74-0.85) and 1-year mortality (OR = 0.81; 95%CI 0.77-0.86). The greatest decrement in 1-year mortality was for pancreatic cancer across all rural-urban categories (OR; 95%CI: metropolitan 0.63; 0.53-0.76; micropolitan 0.53; 0.29-0.97); small town/rural 0.46; 0.25-0.86).
Most Medicare beneficiaries with lung, colon, rectal, or pancreatic cancer bypassed the closest facility providing surgical cancer care, especially rural patients. Bypassing was associated with a lower likelihood of 90-day postoperative, and 1-year mortality. Understanding determinants of bypassing, particularly among rural patients, may reveal potential mechanisms to improve cancer outcomes and reduce rural cancer disparities.
我们研究了外科癌症护理的就医负担与农村地区、绕过最近的外科机构、癌症类型和死亡率之间的关系。
利用医疗保险索赔和参保数据（2016 - 2018年），这些数据来自患有结肠癌、直肠癌、肺癌或胰腺癌的受益人，我们测量了前往以下地点的时间：最近的外科机构和实际就诊的机构。对于那些绕过最近机构的患者，我们研究了就医时间和农村地区与手术率的关系。使用多变量回归模型，我们估计了绕过最近机构与术后90天和一年死亡率之间的关联；将农村地区作为效应修饰因素进行研究。
在211,025名癌症受益人中，25.5%居住在非都市地区。大约66%的大都市/微都市地区患者以及78%的小镇/农村患者绕过了他们最近的机构。农村地区增加与绕过最近机构的可能性显著增加相关（参照组 = 大都市地区，比值比；95%置信区间：微都市地区1.10；1.04 - 1.16，小镇/农村地区2.08；1.96 - 2.20）。绕过最近的机构与术后90天死亡率（比值比 = 0.79；95%置信区间0.74 - 0.85）和一年死亡率（比值比 = 0.81；95%置信区间0.77 - 0.86）降低的可能性相关。在所有城乡类别中，胰腺癌患者一年死亡率下降幅度最大（比值比；95%置信区间：大都市地区0.63；0.53 - 0.76；微都市地区0.53；0.29 - 0.97；小镇/农村地区0.46；0.25 - 0.86）。
大多数患有肺癌、结肠癌、直肠癌或胰腺癌的医疗保险受益人绕过了提供外科癌症护理的最近机构，尤其是农村患者。绕过最近机构与术后90天和一年死亡率较低的可能性相关。了解绕过最近机构的决定因素，特别是在农村患者中，可能揭示改善癌症治疗结果和减少农村癌症差异的潜在机制。
