Thomas Abigail, Dort Joseph Clyde, Nakoneshny Steven C, Matthews Thomas Wayne, Chandarana Shamir, Hart Robert, Sauro Khara M
Department of Community Health Sciences and O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Oncology, Arnie Charbonneau Cancer Institute, Cumming School of Medicine, Univerity of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2025 Apr 1;8(4):e254675. doi: 10.1001/jamanetworkopen.2025.4675.
Head and neck cancer (HNC) epidemiology varies geographically, and rural populations (typically less affluent) may face barriers accessing cancer care, which could lead to worse outcomes.
To compare health care resource use between patients with HNC living in urban and rural areas.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study in Alberta, Canada. Participants were adult patients (aged ≥18 years) diagnosed with HNC with at least 1 year of posttreatment follow-up between January 2012 and September 2020. Data were analyzed from August to September 2024.
Rural location of residence at HNC diagnosis, defined using the forward sortation area of the patients' postal code.
The primary outcomes were health care resource use and patient care trajectories, including hospital length of stay, 30-day hospital readmissions, emergency department visits, time from diagnosis to first treatment, first type of practitioner seen after hospital discharge, and most common practitioner-to-practitioner transitions.
The cohort included 2189 patients with a median (IQR) age of 63 (55-71) years, who were mostly men (1557 patients [71.1%]) with stage IV cancer (1149 patients [52.5%]) of the tongue (640 patients [29.2%]), of which 375 (17.1%) lived in a rural area. There was no difference in cumulative hospital length of stay between urban and rural patients; however, male patients living in rural areas had a longer surgical hospital length of stay than male patients living in urban areas (incidence rate ratio, 1.24; 95% CI, 1.03-1.50). Patients living in rural areas had more 30-day hospital readmissions (63 patients [16.8%] vs 183 patients [10.1%]) and emergency department visits (median [IQR], 8 [3-17] vs 4 [2-9]) than their urban counterparts. Time to first treatment was longer in patients living in rural areas compared with patients living in urban areas (median [IQR], 64 [46-95] days vs 57 [40-84] days). Patients living in rural areas without comorbid conditions had greater odds of being discharged directly to the care of a general practitioner after a hospital stay than urban patients (odds ratio, 1.97; 95% CI, 1.23-3.15).
In this cohort study of patients with HNC, living in rural areas was associated with higher health care resource use than patients living in urban areas. Recommendations specific to patients with HNC living in rural areas may be warranted given these differences.
头颈癌（HNC）的流行病学在地理上存在差异，农村人口（通常较不富裕）在获得癌症治疗方面可能面临障碍，这可能导致更差的治疗结果。
比较城市和农村地区HNC患者的医疗资源使用情况。
设计、设置和参与者：加拿大艾伯塔省的回顾性队列研究。参与者为2012年1月至2020年9月期间被诊断为HNC且至少有1年治疗后随访的成年患者（年龄≥18岁）。数据于2024年8月至9月进行分析。
HNC诊断时的农村居住地点，根据患者邮政编码的前向分拣区定义。
主要结局为医疗资源使用情况和患者护理轨迹，包括住院时间、30天内再次住院、急诊就诊、从诊断到首次治疗的时间、出院后首次就诊的医生类型以及最常见的医生间转诊情况。
该队列包括2189名患者，中位（IQR）年龄为63（55 - 71）岁，大多数为男性（1557名患者[71.1%]），患有IV期癌症（1149名患者[52.5%]），主要为舌癌（640名患者[29.2%]），其中375名（17.1%）居住在农村地区。城市和农村患者的累计住院时间没有差异；然而，居住在农村地区的男性患者手术住院时间比居住在城市地区的男性患者更长（发病率比，1.24；95%CI，1.03 - 1.50）。与城市患者相比，居住在农村地区的患者30天内再次住院的情况更多（63名患者[16.8%]对183名患者[10.1%]），急诊就诊次数也更多（中位[IQR]，8[3 - 17]次对4[2 - 9]次）。与居住在城市地区的患者相比，居住在农村地区患者的首次治疗时间更长（中位[IQR]，64[46 - 95]天对57[40 - 84]天）。与城市患者相比，没有合并症的农村地区患者在住院后直接由全科医生护理的几率更高（优势比，1.97；95%CI，1.23 - 3.15）。
在这项针对HNC患者的队列研究中，居住在农村地区的患者比居住在城市地区的患者医疗资源使用更高。鉴于这些差异，可能需要针对居住在农村地区的HNC患者制定具体建议。
