Residence in Rural Areas of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival

作者：Graham Atkins, Taeha Kim, Jeffrey C. Munson · 发表于：Annals of the American Thoracic Society · 年份：2017 · DOI：10.1513/annalsats.201606-469oc · 被引用次数：162 · 研究领域：Global Cancer Incidence and Screening、Lung Cancer Treatments and Mutations、Lung Cancer Diagnosis and Treatment

RATIONALE: There is increased lung cancer mortality in rural areas of the United States. However, it remains unclear to what extent rural-urban differences in disease incidence, stage at diagnosis, or treatment explain this finding. OBJECTIVES: To explore the relationship between smoking rates, lung cancer incidence, and lung cancer mortality in populations across the rural-urban continuum and to determine whether survival is decreased in rural patients diagnosed with lung cancer and whether this is associated with rural-urban differences in stage at diagnosis or the treatment received. METHODS: We conducted a retrospective cohort study of 348,002 patients diagnosed with lung cancer between 2000 and 2006. Data from metropolitan, urban, suburban, and rural areas in the United States were obtained from the Surveillance, Epidemiology, and End Results program database. County-level population estimates for 2003 were obtained from the U.S. Census Bureau, and corresponding estimates of smoking prevalence were obtained from published literature. The exposure was rurality, defined by the rural-urban continuum code area linked to each cohort participant by county of residence. Outcomes included lung cancer incidence, mortality, diagnostic stage, and treatment received. MEASUREMENTS AND MAIN RESULTS: Lung cancer mortality increased with rurality in a dose-dependent fashion across the rural-urban continuum. The most rural areas had almost twice the smoking prevalence and lung cancer inc...