Incidence, stage of diagnosis and survival of gastro-esophageal cancers in rural, urban and metropolitan areas of the United States: 2004-2009 Open Access

Wang, Zhensheng (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/n296wz24d?locale=en
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Abstract

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.


Results: Using metropolitan 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 areas.


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indicate that certain preconceptions about urban/rural disparities in the United States are either unwarranted or out-of-date at least with respect to gastroesophageal cancers.

Table of Contents

Table of Contents


Background:


Methods:


Results:


Incidence Rates


Predictors of advanced (AJCC stage IV) disease


Survival Analysis


Discussion:


Conclusion:


References:


Tables and Figures

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