Rural-Urban Disparities in Survival for Primary Malignant Brain Cancer: a SEER analysis, 2000-2008 公开
Blain, Amy Elizabeth (2013)
Abstract
Background: Previous studies have identified rural-urban differences in survival for other malignancies, but these differences have not been examined for brain cancer. This study will focus on rural-urban differences in survival for primary malignant brain tumors in adults, controlling for those factors already known to have an effect on survival. Additionally, the study will examine if poverty is a significant confounder when examining rural-urban disparities in survival in the state of Georgia.
Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) Program for cases of primary malignant brain cancer diagnosed from 2000 to 2008 in individuals ≥20 years of age. Unadjusted Kaplan-Meier survival curves and crude 5-year relative survival estimates were used to compare survival across the rural-urban categories. A multivariable Cox proportional hazards model was used to calculate hazard ratios for rural-urban status controlling for age at diagnosis, year of diagnosis, marital status at diagnosis, race, sex, primary tumor site, histology, stage, and treatment type.
Results: 31,713 cases comprised the final analytic dataset. Kaplan-Meier survival curves and 5-year relative survival estimates showed better survival in large metropolitan counties, decreasing across the rural-urban continuum, with the worst survival in rural non-metropolitan counties. Multivariable analysis showed a significant increased risk of death from brain cancer for small metropolitan counties, urban non-metropolitan counties, and rural non-metropolitan counties compared to large metropolitan counties, with the largest risk in rural non-metropolitan counties (HR =1.17; 95% CI: 1.04-1.32). Poverty was not a significant predictor of survival in Georgia, and only small metropolitan and rural non-metropolitan counties had a significant increased risk of death compared to large metropolitan counties.
Conclusion: Brain cancer cases living in small metropolitan counties, urban non-metropolitan counties, and rural non-metropolitan counties are all at a significant increased risk of death from brain cancer compared to cases living large metropolitan counties at the time of diagnosis. Further research is needed to explore the underlying reasons for these differences.
Table of Contents
Background…..……………………………………………………………....…………………1 Introduction……....………………………………………………….……....……1 Risk Factors….…...………………………………………………….……....…...2 Rural-Urban Disparities……....……………………………………………….3 Methods……………………………………………………………………………….............5 Results……………………………………………………………………………………………….9 Discussion………………………………………………………………………………..……..12 Strengths and Limitations……...…….…..……………….……………..13 References……………………………………………………………………………….….….15 Figures and Tables……………………………………………………………….…….……18 Figure 1……………………………………………………………………………....18 Table 1….………..………………….…………………………………………….…19 Table 2…………..………………...…………………………………………………20 Table 3………..……………..……………………………………………….………21 Table 4………..……………..……………………………………………….………21
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