Urban-rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer

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Journal Article
Journal of Epidemiology and Community Health, 2016, 71 (5), pp. 468 - 474
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Background Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancerdirected 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 arealevel data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancerdirected 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 nonsurgical 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.
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