Incidence, stage of diagnosis and survival of gastro-esophageal
cancers in rural, urban and metropolitan areas of the United
States: 2004-2009 Open Access
Permanent URL: https://etd.library.emory.edu/concern/etds/n296wz24d?locale=en Published
Background:This study aimed to
assess the differences of incidence, late stage diagnosis and
prognosis of three malignancies - squamous cell carcinoma of the
esophagus (SCCE), adenocarcinoma of the esophagus (AE) and
adenocarcinoma of the gastric cardia (AGC) - in metro, urban and
rural areas in the United States.
Methods:We identified 29,527 cases
of SCCE, AE or AGC reported to the Surveillance, Epidemiology, and
End Results program between 2004 and 2009. Incidence estimates for
each malignancy were compared across metro, urban and rural areas.
Multivariable logistic regression models were applied to evaluate
the association between residential setting and late (distant
stage) diagnosis with results expressed as adjusted odds ratios
(ORs) and 95% confidence intervals (CIs). Kaplan-Meier survival
curves and Cox proportional hazard models were used to examine the
association between residential setting and survival.
population centers as reference,incidence of AE was found to be
higher in urban (rate ratio [RR]=1.13, 95% CI: 1.06, 1.20) and
rural (RR=1.15, 95%: 1.05, 1.25) areas, while incidence of SCCE was
lower in rural areas (RR=0.80, 95%: 0.70, 0.91). Rural patients
were less likely to be diagnosed with stage IV AE compared to those
residing in metropolitan areas (OR=0.79, 95% CI: 0.65, 0.97). No
significant differences in prognosis of either malignancy were
observed among patients residing in metro, urban and rural
Conclusion:These findings indicate that certain preconceptions about
urban/rural disparities in the United States are either unwarranted
or out-of-date at least with respect to gastroesophageal
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