Journal article
Rural-Urban Differences in Late-Stage Breast Cancer: Do Associations Differ by Rural-Urban Classification System?
Texas public health journal, v 67(2)
2015
PMID: 27158685
Abstract
Rural residence is associated with later stage of breast cancer diagnosis in some but not all prior studies. The lack of a standardized definition of rural residence may contribute to these mixed findings. We characterize and compare multiple definitions of rural vs. non-rural residence to provide guidance regarding choice of measures and to further elucidate rural disparities in breast cancer stage at diagnosis.
We used Texas Cancer Registry data of 120,738 female breast cancer patients ≥50 years old diagnosed between 1995-2009. We defined rural vs. non-rural residence using 7 different measures and examined their agreement using Kappa statistics. Measures were defined at various geographic levels: county, ZIP code, census tract, and census block group. Late-stage was defined as regional or distant disease. For each measure, we tested the association of rural residence and late-stage cancer with unadjusted and adjusted logistic regression. Covariates included: age; patient race/ethnicity; diagnosis year; census block group-level mammography capacity; and census tract-level percent poverty, percent Hispanic, and percent Black.
We found moderate to high levels of agreement between measures of rural vs. non-rural residence. For 72.9% of all patients, all 7 definitions agreed as to rural vs. non-rural residence. Overall, 6 of 7 definitions demonstrated an adverse association between rural residence and late-stage disease in unadjusted and adjusted models (Adjusted OR Range = 1.09-1.14).
Our results document a clear rural disadvantage in late-stage breast cancer. We contribute to the heterogeneous literature by comparing varied measures of rural residence. We recommend use of the census tract-level Rural Urban Commuting Area Codes in future cancer outcomes research where small area data are available.
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Details
- Title
- Rural-Urban Differences in Late-Stage Breast Cancer: Do Associations Differ by Rural-Urban Classification System?
- Creators
- Sandi L PruittJan M EberthE Scott MorrisDavid B Grinsfelder - The University of Texas Southwestern Medical CenterErica L Cuate - The University of Texas Southwestern Medical Center
- Publication Details
- Texas public health journal, v 67(2)
- Grant note
- L60 MD003664 / NIMHD NIH HHS R24 HS022418 / AHRQ HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Other Identifier
- 991021855175904721