TY - JOUR
T1 - Urban-rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer
AU - Thomas, Audrey Alforque
AU - Pearce, Alison
AU - O'Neill, Ciaran
AU - Molcho, Michal
AU - Sharp, Linda
N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
PY - 2017/5
Y1 - 2017/5
N2 - BACKGROUND: Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancer-directed surgery is an influential and significant prognostic factor. In a population-based study, we determined how urban/rural residence was related to surgery receipt for patients with non-small cell lung cancer. We assessed the relationship between relative survival and patients' area of residence, taking into account surgery receipt and area socioeconomic level.METHODS: We extracted data from the National Cancer Registry Ireland on patients with non-small cell lung cancer diagnosed during 1994-2011 and linked to area-level data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancer-directed surgery using logistic regression with postestimation of adjusted proportions. Relative survival estimates with follow-up to 31 December 2012 were calculated for all cases and stratified by surgery receipt, adjusting for clinical variables, area socioeconomic level and other sociodemographic characteristics.RESULTS: 15 031 people diagnosed with non-small cell lung cancer were included in the analysis. On the basis of the multiple logistic regression model, a significantly larger proportion of urban patients (adjusted proportion 23%) as compared with rural patients (adjusted proportion 21%) received surgery (p<0.001). In multivariate analysis, rural residence was significantly related to a decrease in excess mortality for all cases (HR 0.90, 95% CI 0.87 to 0.94, p<0.001) and for non-surgical cases (HR 0.88, 95% CI 0.85 to 0.92, p<0.001).CONCLUSIONS: The findings point to the need for targeted policies addressing access to treatment for rural patients with non-small cell lung cancer.
AB - BACKGROUND: Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancer-directed surgery is an influential and significant prognostic factor. In a population-based study, we determined how urban/rural residence was related to surgery receipt for patients with non-small cell lung cancer. We assessed the relationship between relative survival and patients' area of residence, taking into account surgery receipt and area socioeconomic level.METHODS: We extracted data from the National Cancer Registry Ireland on patients with non-small cell lung cancer diagnosed during 1994-2011 and linked to area-level data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancer-directed surgery using logistic regression with postestimation of adjusted proportions. Relative survival estimates with follow-up to 31 December 2012 were calculated for all cases and stratified by surgery receipt, adjusting for clinical variables, area socioeconomic level and other sociodemographic characteristics.RESULTS: 15 031 people diagnosed with non-small cell lung cancer were included in the analysis. On the basis of the multiple logistic regression model, a significantly larger proportion of urban patients (adjusted proportion 23%) as compared with rural patients (adjusted proportion 21%) received surgery (p<0.001). In multivariate analysis, rural residence was significantly related to a decrease in excess mortality for all cases (HR 0.90, 95% CI 0.87 to 0.94, p<0.001) and for non-surgical cases (HR 0.88, 95% CI 0.85 to 0.92, p<0.001).CONCLUSIONS: The findings point to the need for targeted policies addressing access to treatment for rural patients with non-small cell lung cancer.
KW - Adult
KW - Cancer Survivors/statistics & numerical data
KW - Carcinoma, Non-Small-Cell Lung/epidemiology
KW - Female
KW - Humans
KW - Ireland
KW - Lung Neoplasms/epidemiology
KW - Male
KW - Middle Aged
KW - Registries
KW - Residence Characteristics
KW - Rural Population/statistics & numerical data
KW - Socioeconomic Factors
KW - Urban Population/statistics & numerical data
U2 - 10.1136/jech-2016-208113
DO - 10.1136/jech-2016-208113
M3 - Article
C2 - 27913615
SN - 0143-005X
VL - 71
SP - 468
EP - 474
JO - Journal of Epidemiology and Community Health
JF - Journal of Epidemiology and Community Health
IS - 5
ER -
