Impact of Rurality on Stage IV Ovarian Cancer at Diagnosis: A Midwest Cancer Registry Cohort Study

被引:14
|
作者
Weeks, Kristin S. [1 ,2 ]
Lynch, Charles F. [2 ,3 ]
West, Michele [3 ]
McDonald, Megan [4 ]
Carnahan, Ryan [2 ]
Stewart, Sherri L. [5 ]
Charlton, Mary [2 ,3 ]
机构
[1] Univ Iowa, Carver Coll Med, Iowa City, IA USA
[2] Univ Iowa, Dept Epidemiol, Iowa City, IA USA
[3] Univ Iowa, State Hlth Registry Iowa, Iowa Canc Registry, Iowa City, IA USA
[4] Univ Iowa Hosp & Clin, Dept Obstet & Gynecol, Div Gynecol Oncol, Iowa City, IA 52242 USA
[5] Ctr Dis Control & Prevent, Div Canc Prevent & Control, Atlanta, GA USA
关键词
cancer stage; epidemiology; geographic disparities; health disparities; ovarian cancer; CHARLSON COMORBIDITY INDEX; BREAST-CANCER; URBAN DISPARITIES; UNITED-STATES; HEALTH; SURVIVAL; RISK; CARE; BEHAVIORS; RESIDENCE;
D O I
10.1111/jrh.12419
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Purpose We aim to understand if rurality impacts patients' odds of presenting with stage IV ovarian cancer at diagnosis independent of distance to primary care provider and the socioeconomic status of a patient's residential census tract. Methods A cohort of 1,000 women with ovarian cancer in Iowa, Kansas, and Missouri were sampled and analyzed from the cancer registries' statewide population data. The sample contained those with a histologically confirmed primary ovarian cancer diagnosis in 2011-2012. All variables were captured through an extension of standard registry protocol using standardized definitions and abstraction manuals. Chi-square tests and a multivariable logistic regression model were used. Findings At diagnosis, 111 women in our sample had stage IV cancer and 889 had stage I-III. Compared to patients with stage I-III cancer, patients with stage IV disease had a higher average age, more comorbidities, and were more often living in rural areas. Multivariate analysis showed that rural women (vs metropolitan) had a greater odds of having stage IV ovarian cancer at diagnosis (odds ratio = 2.41 and 95% confidence interval = 1.33-4.39). Conclusion Rural ovarian cancer patients have greater odds of having stage IV cancer at diagnosis in Midwestern states independent of the distance they lived from their primary care physician and the socioeconomic status of their residential census tract. Rural women's greater odds of stage IV cancer at diagnosis could affect treatment options and mortality. Further investigation is needed into reasons for these findings.
引用
收藏
页码:468 / 475
页数:8
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