Rural-Urban Differences in Esophagectomy for Cancer

Background: Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer. Study Design: An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared. Results: A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167). Conclusions: This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients.

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Impact of rural/urban residence on relative survival (RS) in patients with kidney cancer: An analysis of 14576 patients from the Austrian National Cancer Registry (ANCR).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.491 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 491-491 ◽

Cited By ~ 1

Author(s):

Martin Marszalek ◽

Henrike E Karim-Kos ◽

Stephan Madersbacher ◽

Monika Hackl ◽

Michael Rauchenwald

Keyword(s):

Cancer Patients ◽

Kidney Cancer ◽

Rural Areas ◽

Relative Survival ◽

Medical Diagnostics ◽

Rural Residence ◽

Rural And Urban ◽

Medical Health Care ◽

Urban Rural ◽

Rural Patients

491 Background: Access to medical diagnostics and treatment might be limited for patients living in rural areas compared to urban residents. To evaluate the potential impact of urban/rural residence, we analyzed trends in RS for patients diagnosed with kidney cancer between 1998 and 2009 in Austria. Methods: All patients with kidney cancer aged ≥18 years, diagnosed from 1998-2009 were derived from the ANCR (n=14,576). Patients were categorized into two groups: rural (n=7,537) and urban (n=7,039) based on a complex algorithm considering infrastructure, commuter interrelations, accessibility of centers, and tourism at the time of diagnosis. Relative survival was calculated based on complete follow-up until December 31st, 2014. Poisson regression modeling was used to evaluate survival differences between the two groups and to calculate the relative excess risk of dying (RER). Analyses were performed for the total patient population and primary metastatic patients (M+). Results: Distribution of sex, age, stage of disease, year of diagnosis, and surgical treatment did not differ between rural and urban patients. Five-year RS was 74% for rural compared to 73% for urban patients (RER for rural: 0.88, 95% CI 0.81-0.95). In M+ patients, 5-year RS was 14% for both residence groups. On multivariate analysis, residence remained as an independent predictor for survival in the overall kidney cancer population (RER of rural patients 0.87, 95% CI 0.81-0.94). For M+ patients the RER was 0.90 ( 95% CI 0.81-1.00). For patients without surgery, rural patients were even stronger benefited in their survival than urban patients (overall population: RER 0.81, 95% CI 0.74-0.89; M+ patients: RER 0.84, 95% CI 0.73-0.97) wherereas in surgical patients RS did not differ between rural and urban patients. Conclusions: An advantage in RS was observed for kidney cancer patients living in rural areas. This advantage was evident in metastatic and non-metastatic patients, especially in patients who did not undergo surgery for (metastatic) kidney cancer. These results suggest that access to medical health care for kidney cancer patients in Austria is not limited by rural residence.

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Impact of rural/urban residence on relative survival (RS) in patients with kidney cancer: An analysis of 14576 patients from the Austrian National Cancer Registry (ANCR).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e16072 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e16072-e16072

Author(s):

Martin Marszalek ◽

Henrike E Karim-Kos ◽

Stephan Madersbacher ◽

Michael Rauchenwald ◽

Monika Hackl

Keyword(s):

Cancer Patients ◽

Kidney Cancer ◽

Rural Areas ◽

Relative Survival ◽

Medical Diagnostics ◽

Rural Residence ◽

Rural And Urban ◽

Medical Health Care ◽

Urban Rural ◽

Rural Patients

e16072 Background: Access to medical diagnostics and treatment might be limited for patients living in rural areas compared to urban residents. To evaluate the potential impact of urban/rural residence, we analyzed trends in RS for patients diagnosed with kidney cancer between 1998 and 2015 in Austria. Methods: All patients with kidney cancer aged ≥18 years, diagnosed between 1998 and 2015 were derived from the ANCR (N = 22,041). Patients were categorized into two groups: rural (N = 7,53) and urban (N = 10,552) based on a complex algorithm considering infrastructure, commuter interrelations, accessibility of centers and tourism at the time of diagnosis. Relative survival was calculated based on complete follow-up until December 31st, 2016. Poisson regression modeling was used to evaluate survival differences between the two groups and to calculate the relative excess risk of dying (RER). Analyses were performed for the total patient population and primary metastatic patients (M+, N = 2,490). Results: Distribution of age and surgical treatment did not differ between rural and urban patients. Five-year RS was 75% for rural patients compared to 73% for urban patients (RER for rural: 0.85, 95%CI 0.80-0.91). In M+ patients, 5-year RS was 14% for urban patients and 15% for rural patients (p = .02) Multivariate analysis showed that residence remained as an independent predictor for survival in the overall kidney cancer population (RER of rural patients 0.84, 95%CI 0.78-0.89). For M+ patients the RER of rural patients was 0.86 ( 95%CI 0.79-0.94) compared to urban M+ patients. For patients without surgery, rural patients were even stronger benefited in their survival than urban patients (overall population: RER 0.77, 95% CI 0.71-0.83; M+ patients: RER 0.81, 95%CI 0.72-0.91) wherereas in surgical patients RS did not differ between rural and urban patients. Conclusions: An advantage in RS was observed for kidney cancer patients living in rural areas. This advantage was evident in metastatic and non-metastatic patients, especially in patients who did not undergo surgery for (metastatic) kidney cancer. These results suggest that access to medical health care for kidney cancer patients in Austria is not limited by rural residence.

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Urban–rural disparity in cancer incidence in China, 2008–2012: a cross-sectional analysis of data from 36 cancer registers

BMJ Open ◽

10.1136/bmjopen-2020-042762 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042762

Author(s):

Shuai Yuan ◽

Shao-Hua Xie

Keyword(s):

Cancer Incidence ◽

Rural Areas ◽

Urban Areas ◽

Incidence Rates ◽

Cancer Type ◽

Anatomic Site ◽

Cross Sectional ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Urban Rural

ObjectiveThe substantial differences in socioeconomic and lifestyle exposures between urban and rural areas in China may lead to urban–rural disparity in cancer risk. This study aimed to assess the urban–rural disparity in cancer incidence in China.MethodsUsing data from 36 regional cancer registries in China in 2008–2012, we compared the age-standardised incidence rates of cancer by sex and anatomic site between rural and urban areas. We calculated the rate difference and rate ratio comparing rates in rural versus urban areas by sex and cancer type.ResultsThe incidence rate of all cancers in women was slightly lower in rural areas than in urban areas, but the total cancer rate in men was higher in rural areas than in urban areas. The incidence rates in women were higher in rural areas than in urban areas for cancers of the oesophagus, stomach, and liver and biliary passages, but lower for cancers of thyroid and breast. Men residing in rural areas had higher incidence rates for cancers of the oesophagus, stomach, and liver and biliary passages, but lower rates for prostate cancer, lip, oral cavity and pharynx cancer, and colorectal cancer.ConclusionsOur findings suggest substantial urban–rural disparity in cancer incidence in China, which varies across cancer types and the sexes. Cancer prevention strategies should be tailored for common cancers in rural and urban areas.

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Abstract 13706: Differences in the Distribution of Systolic Blood Pressure by Rural and Urban Residence

Circulation ◽

10.1161/circ.142.suppl_3.13706 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Brittain Heindl ◽

George Howard ◽

Elizabeth A Jackson

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Racial Differences ◽

Rural Areas ◽

Urban Areas ◽

Census Bureau ◽

Urban Group ◽

Rural And Urban ◽

Urban Rural ◽

The Difference

Introduction: The incidence of stroke is higher in rural areas. Hypertension is the leading risk factor for stroke, but the difference in systolic blood pressure (SBP) for those living in rural and urban areas is unknown. Hypothesis: We hypothesized that rural residence is associated with higher SBP levels, and this difference is modified by race, sex, and United States (US) division. Methods: We analyzed 26,113 participants enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, recruited between 2003 and 2007. Participants were grouped based on the Rural-Urban Commuting Area (RUCA) scheme into urban, large-rural, and small-isolated rural groups. Resting SBP was measured during the initial home visit. Differences in percentiles of SBP distribution were compared using multivariate models with adjustment for age, race, sex, and US Census Bureau division. Results: Of the participants, 20,976 (80.3%) were classified as urban, 3,020 (11.6%) as large-rural, and 2,137 (8.2%) as small-isolated rural, reflecting the distribution of the population. The large-rural group had a 0.09 mmHg higher mean SBP compared to the urban group (95% CI, 0.33 to 1.52 mmHg, p = 0.0023), but the difference in SBP at the 95th percentile between these groups was 3.23 mmHg (95% CI, 1.43 to 4.73 mmHg, p = 0.0006). A similar difference was present between the small-isolated rural and urban groups at the highest percentiles. No urban-rural interaction was observed by race, sex, or US division. However, large SBP differences were present between US divisions, especially at the highest percentiles. To illustrate, SBP at the 95th percentile was 9.51 mmHg higher in the East North Central division than in the Pacific (95% CI, 6.41 to 12.61 mmHg, p < 0.0001). Conclusions: Residence in a rural area is associated with higher SBP, with larger differences at the highest percentiles of distribution. SBP differences are present between US divisions, independent of urban-rural status.

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Creating healthy and active life for the elderly in programmes conducted by rural and urban-rural communes in Poland

European Journal of Public Health ◽

10.1093/eurpub/ckaa154 ◽

2020 ◽

Author(s):

Anna Augustynowicz ◽

Michał Waszkiewicz ◽

Sławomir Szopa ◽

Mariola Borowska ◽

Aleksandra Czerw

Keyword(s):

Health Policy ◽

Rural Areas ◽

The Elderly ◽

Analysis Data ◽

Healthy Life ◽

Aggregate Information ◽

Active Life ◽

Rural And Urban ◽

Urban Rural ◽

Family Activity

Abstract Background In Poland, between 1989 and 2018 the number of the elderly increased by over 3.9 million. Demographic changes justify a senior policy focussed on the longest possible social, professional and family activity of the elderly. Directions of undertaken actions should include health policy programmes aimed at creating conditions healthy and active life of the elderly. The programmes should be particularly important in rural areas as the health of rural and urban residents differs. The study presents programmes for creating conditions for a healthy and active life of the elderly run by rural and urban-rural communes in 2012–17. Methods The study was conducted on the basis of existing data analysis. Data from the summary information prepared by voivodes and provided to the Minister of Health about implemented health policy programmes were used. Data on programmes concerning a healthy and active life for the elderly conducted by rural and urban-rural communes between 2012 and 2017 were extracted from the aggregate information. Results Between 2012 and 2017, 354 programmes were implemented, the most in 2016, and the least in 2015. There were 171 000 people participating in the programmes. The total cost was USD 2 491 664. Conclusion It can be presumed that in 2016 communes implemented more diagnostic and therapeutic programmes than in 2017. A small number of programmes and a small involvement of financial resources in communes with the largest number of the elderly may indicate marginalization of the importance of an active and healthy life for the elderly.

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Assessing cancer programs' financial resources for rural cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.165 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 165-165

Author(s):

Victoria Marie Petermann ◽

Robin C. Vanderpool ◽

Jan Marie Eberth ◽

Catherine Rohweder ◽

Randall Teal ◽

...

Keyword(s):

Cancer Patients ◽

Rural Areas ◽

Insurance Coverage ◽

Cancer Control ◽

Financial Resources ◽

Financial Toxicity ◽

Cancer Care Facilities ◽

Rural And Urban ◽

Housing Costs ◽

Rural Patients

165 Background: The National Cancer Institute (NCI) has identified rural cancer control as a research priority. Rural patients may have greater cancer-related financial burdens due to high travel costs, low insurance coverage, and less flexible work schedules. To better understand geographic differences in cancer-related financial toxicity from an organizational perspective, we interviewed staff from a range of cancer treatment settings in counties across the rural-urban continuum. The goal was to qualitatively assess the financial resources available to cancer patients, particularly those residing in rural areas. Methods: Seven research teams within the Cancer Prevention and Research Control Network interviewed personnel providing financial navigation services across four types of cancer care facilities and three urban/rural classifications. Interviews were audio-recorded and transcribed. We identified themes using inductive content analysis. A total of 28 interviews were collected across 7 states and preliminary results have been generated from 20 interviews. Results: Study participants identified transportation and housing costs as primary financial stressors for rural patients. A few personnel from centers in urban counties did not observe clear differences in experiences of financial toxicity between rural and urban patients. No personnel mentioned resources that are long-term or specifically for rural patients. Gas cards and temporary housing are often provided to help rural and urban patients access treatment. Insufficient staffing is a barrier to addressing patients’ financial concerns in rural and urban centers. Urban institutions, particularly NCI-designated facilities, employ more cancer-specific financial navigators than rural institutions. Conclusions: Patients across the rural-urban continuum experience financial hardship, but rural patients may be disproportionately affected by transportation and housing costs. Improving transportation and housing support may improve their ability to access treatment. Financial navigation practices within states vary; thus, patients and cancer centers may benefit from more streamlined approaches to address financial needs for all cancer patients.

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Language Variation and Change in Rural Communities

Annual Review of Linguistics ◽

10.1146/annurev-linguistics-011817-045545 ◽

2019 ◽

Vol 5 (1) ◽

pp. 435-453

Author(s):

Matthew J. Gordon

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Social Dynamics ◽

Language Variation ◽

Language Variation And Change ◽

Dialect Contact ◽

Cultural Divide ◽

Rural And Urban ◽

Speech Communities ◽

Urban Rural

Despite the difficulty of delineating the rural from the urban according to economic or demographic criteria, this distinction has powerful cultural resonances, and language plays a key role in constructing the cultural divide between rural and urban. Sociolinguists have generally devoted more attention to urban communities, but substantial research has explored language variation and change in rural areas, and this scholarship complements the perspective gained from studies of metropolitan speech. This article reviews research on rural speech communities that examines the linguistic dimensions of the urban/rural divide as well as social dynamics driving language variation and change in rural areas. One theme emerging from this literature is the role of dialect contact and how its effects are shaped by material as well as attitudinal factors.

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THE DIFFERENTIATION IN THE LEVEL OF SOCIOECONOMIC DEVELOPMENT OF RURAL AREAS OF THE LOWER SILESIAN PROVINCE IN THE YEARS 2002 AND 2010

Annals of the Polish Association of Agricultural and Agribusiness Economists ◽

10.5604/01.3001.0013.2200 ◽

2019 ◽

Vol XXI (2) ◽

pp. 170-187

Author(s):

Barbara Kutkowska ◽

Tomasz Pilawka ◽

Vitalii Rybchak ◽

Olena Rybchak

Keyword(s):

Rural Areas ◽

Socioeconomic Development ◽

Pearson Correlation ◽

Standard Of Living ◽

Linear Ordering ◽

The European Union ◽

Rural And Urban ◽

Gradual Process ◽

Urban Rural ◽

Lower Silesia

A gradual process of convergence of our country with the bloc’s member states has been observed since Poland’s accession to the European Union. The advance in the standard of living and living conditions of the inhabitants attests to this. The study area included rural and urban-rural communes of Lower Silesia. The research was aimed at determining the differentiation of the level of socioeconomic development within the Lower Silesian region and establishing whether changes in growth serve to increase or decrease this diversification. The level of socioeconomic development in 2002 and 2010 was determined based on available data. In order to determine the differentiation, a hierarchical method of linear ordering and statistical methods were applied, including the Pearson correlation coefficient, as well as the coefficients of variability and determination. The studies showed that differentiation in terms of the level of socioeconomic development in the province’s rural areas deepened in the years 2002-2010 . It was noted that despite significant changes in most indicators characterizing socioeconomic development, growth progressed unevenly and was spatially diversified. Communes with the highest level of development were located around urban agglomerations, however, those communes which saw the fastest development did not form a compact territory around cities.

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Imbalanced Development and Economic Burden for Urban and Rural Wastewater Treatment in China—Discharge Limit Legislation

Sustainability ◽

10.3390/su10082597 ◽

2018 ◽

Vol 10 (8) ◽

pp. 2597 ◽

Cited By ~ 5

Author(s):

Meishu Wang ◽

Hui Gong

Keyword(s):

Wastewater Treatment ◽

Rural Development ◽

Economic Burden ◽

Rural Areas ◽

Financial Burden ◽

Urban Regions ◽

Rural And Urban ◽

Water Legislation ◽

Urban Rural ◽

Rural Wastewater

Water pollution control is a great challenge for China. Compared with urban regions, the wastewater treatment in rural areas is much undeveloped, which is highly related with the much delayed legislation for rural wastewater. Imbalanced urban-rural development and the economic burden of urban and rural wastewater treatment in China was investigated from the perspective of discharge limit legislation. For now, the national discharge limit for rural wastewater is still vacant, although the national discharge limit for urban wastewater had been released for more than ten years. Recently, local rural wastewater discharge limits from several provinces were released, however, based on quite different principles. Some categories emphasized environmental sensitivity with the discharge limit equal and were more strict than urban standards, while some focused on resource recovery for rural regions with loose discharge limits. This study compared the financial burden between rural and urban regions in 31 provinces under different discharge limit legislation conditions. It was revealed that the resources recovery category discharge principle helped to decrease the financial burden imbalance with a reduced Gini coefficient from 0.37 to 0.17. The reduced economic burden from the implementation of a suitably designed rural discharge limit promoted balancing the rural-urban gap and lowering uncertainties and risk of sustainable rural wastewater treatment. This study also revealed the urgency of rural water legislation and proposed development with a balanced financial burden for urban and rural residents under suitable discharge limits, providing a profound insight for environmental management with a focus on balanced urban-rural development for the policy-makers in developing countries.

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Trends of Rural/Urban Homicide in Colombia, 1992-2015: Internal Armed Conflict and Hints for Postconflict

BioMed Research International ◽

10.1155/2018/6120909 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Katherine Vallejo ◽

Jose Tapias ◽

Ivan Arroyave

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Armed Conflict ◽

Homicide Rates ◽

Internal Armed Conflict ◽

Rural And Urban ◽

Inflection Points ◽

Younger Men ◽

Urban Rural ◽

Rate Ratios

Objective. To analyze the relationship between rural and urban homicide rates in Colombia between 1992 and 2015 and the fluctuations in these rates. Methods. Individual records of homicides and population aggregates in men and women aged 15-64 years were used. The adjusted rates of annual homicides were calculated for urban/rural areas and standardized by age. Rate Ratios (RRs) adjusted by region were calculated. A joinpoint analysis was performed to identify inflection points and the Annual Percentage Change (APC). Results. Four joinpoints were identified in rural and urban rates: after peaking in 1992, homicide rates fell until 1997, and then increased until 2002. From this point on there was a continuous reduction until 2015, although this reduction slowed down from 2005 onward. During almost the whole period, the rates of rural homicides were higher than those of urban homicides, although they equalized at the end of the period. Conclusions. Unlike in other countries, during the study period Colombian homicide rates, which coincided with the dynamics of the armed conflict, were higher in rural than in urban areas. In recent years, a predominance of urban homicides committed by younger men has been identified, which could pose a challenge to postconflict in Colombia.

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