The impact of rural residence on adult brain cancer survival in the United States
The impact of rural residence on adult brain cancer survival in the United States
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DOI：
10.1007/s11060-019-03254-4
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发表时间：
2019-09-01
影响因子：
3.9
通讯作者：
Pham, Martin H.
中科院分区：
文献类型：
--
作者：
Delavar, Arash;Al Jammal, Omar M.;Pham, Martin H.
目的脑癌生存率城乡差异的研究已有报道。然而，癌症类型或整个美国的差异仍然知之甚少。使用监测、流行病学和最终结果(SEER)18登记数据库，我们检查了由城乡连续编码(RUCC)定义的城乡居民的脑癌存活率。方法我们从2001年至2011年20岁及以上的首次恶性脑癌患者的SEER 18个登记中获得数据。诊断时使用大都市/非大都市县分类和单个RCCC类别来定义农村/城市住宅。我们使用COX比例风险回归来计算调整后的危险比(HR)和城乡居住地与脑癌存活率之间的关联的95%可信区间(CI)。结果37581例癌症患者中，非西班牙裔白人占77.9%，男性占56.5%，大都市县占88.7%。生活在大多数农村的脑癌患者与生活在大多数城市的患者相比，癌症死亡的风险显著增加(HR 1.15；95%CI 1.01-1.31)。生活在非大城市县的人与生活在大城市县的人相比，癌症死亡的风险相似(HR 1.01；95%CI 0.97-1.06)。根据癌症类型观察总体效果调整，非特异性少突胶质细胞瘤(HR 1.35；95%CI 1.01-1.81)显示出最大的效果。结论在调整混杂因素后，我们的结果表明农村居民对脑癌生存率的影响不大，而且这种差异可能因癌症类型而异。未来的研究应该探索农村和城市脑癌患者治疗策略的差异。
Purpose Rural/urban disparities in brain cancer survival have been reported. However, disparities by cancer type or in the United States as a whole remain poorly understood. Using the Surveillance, Epidemiology, and End Results (SEER) 18 registries database, we examined brain cancer survival by rural/urban residence defined by Rural-Urban Continuum Codes (RUCCs). Methods We obtained data from SEER 18 registries for individuals aged 20 years and older with a first primary malignant brain cancer from 2001 to 2011. Rural/urban residence at diagnosis was defined using both metropolitan/non-metropolitan county classifications and individual RUCC categories. We used Cox proportional hazards regression to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between rural/urban residence and brain cancer survival. Results Among 37,581 cancer cases, 77.9% were non-Hispanic White, 56.5% were male, and 88.7% lived in a metropolitan county. Brain cancer patients living in the most rural counties had a significant increased risk of cancer death compared to those living in the most urban counties (HR 1.15; 95% CI 1.01-1.31). Those living in non-metropolitan counties had a similar risk of cancer death compared to those living in metropolitan counties (HR 1.01; 95% CI 0.97-1.06). Effect modification was observed overall by cancer type, with non-specified oligodendroglioma (HR 1.35; 95% CI 1.01-1.81) showing the greatest effect. Conclusion After adjusting for confounding factors, our results suggest that rural residence has a modest effect on brain cancer survival, and that this disparity may vary by cancer type. Future research should explore differences in treatment strategies between rural and urban brain cancer patients.