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Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study
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 rur...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867495/ https://www.ncbi.nlm.nih.gov/pubmed/32246494 http://dx.doi.org/10.1111/jrh.12429 |
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author | Sanchez, Rolando Zhou, Yunshu Vaughan Sarrazin, Mary S. Kaboli, Peter J. Charlton, Mary Hoffman, Richard M. |
author_facet | Sanchez, Rolando Zhou, Yunshu Vaughan Sarrazin, Mary S. Kaboli, Peter J. Charlton, Mary Hoffman, Richard M. |
author_sort | Sanchez, Rolando |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8867495 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
record_format | MEDLINE/PubMed |
spelling | pubmed-88674952022-02-24 Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study Sanchez, Rolando Zhou, Yunshu Vaughan Sarrazin, Mary S. Kaboli, Peter J. Charlton, Mary Hoffman, Richard M. J Rural Health Article 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. 2020-09 2020-05-30 /pmc/articles/PMC8867495/ /pubmed/32246494 http://dx.doi.org/10.1111/jrh.12429 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Article Sanchez, Rolando Zhou, Yunshu Vaughan Sarrazin, Mary S. Kaboli, Peter J. Charlton, Mary Hoffman, Richard M. Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title | Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title_full | Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title_fullStr | Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title_full_unstemmed | Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title_short | Lung Cancer Staging at Diagnosis in the Veterans Health Administration: Is Rurality an Influencing Factor? A Cross-Sectional Study |
title_sort | lung cancer staging at diagnosis in the veterans health administration: is rurality an influencing factor? a cross-sectional study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8867495/ https://www.ncbi.nlm.nih.gov/pubmed/32246494 http://dx.doi.org/10.1111/jrh.12429 |
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