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Am J Public Health. 2008 Jul;98(7):1280-7. Epub 2007 Oct 30.

An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries.

Author information

1
RAND Corporation, Santa Monica, CA 90407-2138, USA. lisas@rand.org

Abstract

OBJECTIVES:

We tested the relationship between urban or rural residence as defined by rural-urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer.

METHODS:

We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073).

RESULTS:

We found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract-level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality.

CONCLUSIONS:

Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries' potential disadvantage when it comes to receiving needed care in a timely fashion.

PMID:
17971555
PMCID:
PMC2424098
DOI:
10.2105/AJPH.2006.099416
[Indexed for MEDLINE]
Free PMC Article

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