Rural Residence and Cancer Outcomes in the United States: Issues and Challenges

Abstract

Abstract"Neighborhoods and health" research has shown that area social factors are associated with the health outcomes that patients with cancer experience across the cancer control continuum. To date, most of this research has been focused on the attributes of urban areas that are associated with residents' poor cancer outcomes with less focused on attributes of rural areas that may be associated with the same. Perhaps because there is not yet a consensus in the United States regarding how to define "rural," there is not yet an accepted analytic convention for studying issues of how patients' cancer outcomes may vary according to "rural" as a contextual attribute. The research that exists reports disparate findings and generally treats rural residence as a patient attribute rather than a contextual factor, making it difficult to understand what factors (e.g., unmeasured individual poverty, area social deprivation, area health care scarcity) may be mediating the poor outcomes associated with rural (or non-rural) residence. Here, we review literature regarding the potential importance of rural residence on cancer patients' outcomes in the United States with an eye towards identifying research conventions (i.e., spatial and analytic) that may be useful for future research in this important area. Cancer Epidemiol Biomarkers Prev; 22(10); 1657-67. Ó2013 AACR.

Urban/Rural Differences in Breast and Cervical Cancer Incidence: The Mediating Roles of Socioeconomic Status and Provider Density

“…Intra-county heterogeneity could lead to overgeneralizations of ecological associations, and other studies have used smaller units, such as census tracts (Meilleur et al, 2013); however, data availability precluded this approach in the current study. Using the USDA rural-urban continuum codes to measure urbanicity could be problematic in that the nine categories may not truly represent a continuous construct; however, previous studies have evaluated this continuum as a continuous measure, and across studies of urbanicity, studies using this indicator find similar results to studies using other indicators, such as rural-urban commuting area codes (Meilleur et al, 2013). As noted above, our analyses covered only the SEER areas, so the findings may not be generalizable to the rest of the country.…”

Paths to health equity: Local area variation in progress toward eliminating breast cancer mortality disparities, 1990‐2009

“…24 Research has shown an inverse association between educational attainment and cancer mortality. 25 Several studies also report decreased access to cancer screening and worse outcomes for women in rural areas, 26, 27 although one Chicago study showed an urban disadvantage. 28 …”

Association Between Individual and Geographic Factors and Nonadherence to Mammography Screening Guidelines

“…[11][12][13][14] In the context of measuring disparities between rural and nonrural patients, Meilleur and colleagues explain that the lack of consistent findings may result from inconsistencies in how rural is defined. 15 And for measures of geographic access (e.g., ratio of mammography facilities to women), the discrepancies between studies may be a result of how access is defined or measurement bias. For example, most geographic studies to date used measures of access at the county level, which can mask the heterogeneity of travel times to mammography facilities within the county, and many did not account for the use of mammography facilities outside the respondents' counties or across state boundaries.…”