Journal article
Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study
The Journal of rural health, Vol.36(4), pp.484-495
09/01/2020
DOI: 10.1111/jrh.12429
PMCID: PMC8867495
PMID: 32246494
Abstract
Purpose To evaluate the association between rurality and lung cancer stage at diagnosis.
Methods We conducted a cross-sectional study using Veterans Health Administration (VHA) data to identify veterans newly diagnosed with lung cancer between October 1, 2011 and September 30, 2015. We defined rurality, based on place of residence, using Rural-Urban Commuting Area (RUCA) codes with the subcategories of urban, large rural, small rural, and isolated. We used multivariable logistic regression models to determine associations between rurality and stage at diagnosis, adjusting for sociodemographic and clinical characteristics. We also analyzed data using the RUCA code for patients' assigned primary care sites and driving distances to primary care clinics and medical centers.
Findings We identified 4,220 veterans with small cell lung cancer (SCLC) and 25,978 with non-small cell lung cancer (NSCLC). Large rural residence (compared to urban) was associated with early-stage diagnosis of NSCLC (OR = 1.12; 95% CI: 1.00-1.24) and SCLC (OR = 1.73; 95% CI: 1.18-1.55). However, the finding was significant only in the southern and western regions of the country. White race, female sex, chronic lung disease, higher comorbidity, receiving primary care, being a former tobacco user, and more recent year of diagnosis were also associated with diagnosing early-stage NSCLC. Driving distance to medical centers was inversely associated with late-stage NSCLC diagnoses, particularly for large rural areas.
Conclusions We did not find clear associations between rurality and lung cancer stage at diagnosis. These findings highlight the complex relationship between rurality and lung cancer within VHA, suggesting access to care cannot be fully captured by current rurality codes.
Details
- Title: Subtitle
- Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study
- Creators
- Rolando Sanchez - Iowa City VA Health Care SystemYunshu Zhou - University of IowaMary Vaughan Sarrazin - VHA (United States)Peter J. Kaboli - Iowa City VA Health Care SystemMary Charlton - University of IowaRichard M. Hoffman - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.36(4), pp.484-495
- DOI
- 10.1111/jrh.12429
- PMID
- 32246494
- PMCID
- PMC8867495
- NLM abbreviation
- J Rural Health
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Publisher
- Wiley
- Number of pages
- 12
- Grant note
- Veterans Rural Health Resource Center PO30 CA086862 / University of Iowa Holden Comprehensive Cancer Center N32-FY16Q1-S1-P01577 / Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health; US Department of Veterans Affairs CIN 13-412 / Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center
- Language
- English
- Date published
- 09/01/2020
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359875802771
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