Urban–Rural Variations in Quality of Care Among Patients With Cancer in California

Parikh‐Patel, Arti; Morris, Cyllene R.; Kizer, Kenneth W.; Wun, Theodore; Keegan, Theresa H.M.

doi:10.1016/j.amepre.2021.05.021

Cited by 13 publications

(12 citation statements)

References 47 publications

(21 reference statements)

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“…On the other hand, we also observed that compared to large metro PCa survivors, a significantly higher proportion of rural PCa survivors were untreated, which was consistent with previous studies [ 42 , 43 ]. The untreated rural PCa survivors on average reported significantly lower scores for obtaining needed care and a lower rating for health plans as compared to their large metro counterparts.…”

Section: Discussionsupporting

confidence: 93%

Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

Pandit

Patil

Mostafa

et al. 2023

Cancers

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Background: We sought to evaluate rural–urban disparities in patient care experiences (PCEs) among localized prostate cancer (PCa) survivors at intermediate-to-high risk of disease progression. Methods: Using 2007–2015 Surveillance Epidemiology and End Results (SEER) data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, we analyzed survivors’ first survey ≥6 months post-diagnosis. Covariate adjusted linear regressions were used to estimate associations of treatment status (definitive treatment vs. none) and residence (large metro vs. metro vs. rural) with PCE composite and rating measures. Results: Among 3779 PCa survivors, 1798 (53.2%) and 370 (10.9%) resided in large metro and rural areas, respectively; more rural (vs. large metro) residents were untreated (21.9% vs. 16.7%; p = 0.017). Untreated (vs. treated) PCa survivors reported lower scores for doctor communication (ß = −2.0; p = 0.022), specialist rating (ß = −2.5; p = 0.008), and overall care rating (ß = −2.4; p = 0.006). While treated rural survivors gave higher (ß = 3.6; p = 0.022) scores for obtaining needed care, untreated rural survivors gave lower scores for obtaining needed care (ß = −7.0; p = 0.017) and a lower health plan rating (ß = −7.9; p = 0.003) compared to their respective counterparts in large metro areas. Conclusions: Rural PCa survivors are less likely to receive treatment. Rural–urban differences in PCEs varied by treatment status.

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Section: Discussionsupporting

confidence: 93%

Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

Pandit

Patil

Mostafa

et al. 2023

Cancers

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“…Patients living in or near urban areas are more likely to have aggressive end-of-life care compared to those in rural areas. 16,17 There may also be regional differences in systemic inequities. In Texas, Hispanic and black cancer patients are more likely to receive aggressive end-of-life care and die in the hospital compared to non-Hispanic whites.…”

Section: Main Findings/results Of the Studymentioning

confidence: 99%

Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE)

Shepard

Snih

Burke

et al. 2022

Am J Hosp Palliat Care

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Background Hospice use is lower among ethnic/racial minorities in the United States, though little is known about trends, associated factors and duration of hospice use by Mexican-Americans. Aim The purpose of this study is to examine Mexican-American characteristics associated with hospice stay, both ≤ and > 7 days. Design This retrospective cohort study used data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) and the Centers for Medicare and Medicaid Services. Multivariate logistic regression models were used to estimate the ORs and 95% CIs for hospice stay among Mexican-Americans, both ≤ and > 7 days. Setting and participants The first cohort (N = 970) includes H-EPESE participants who died between 2004 and 2016 who had Medicare parts A and B. The second cohort (N = 403) includes participants who completed the H-EPESE survey within the last 2 years of life. Results Although hospice use increased among Mexican-Americans between 2004 and 2016 (OR 1.88, 95% CI 1.19-2.97), 38% of participants died within the first week of hospice care. Mexican-Americans in New Mexico and Arizona were 2-4 times more likely to use hospice than those in Texas and Colorado. Dementia was associated with hospice use (OR 1.47, 95% CI 1.11-1.94). Characteristics, like church attendance and living alone, were not associated with hospice use. Conclusions The substantial proportion of Mexican-Americans with 7 days or less of hospice use underscores the need for early palliative/hospice intervention to mitigate variation in use.

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“…We found patients with EOGC and LOGC residing in locations that were not adjacent to metropolitan areas were less likely to receive surgery than those residing in metropolitan areas ( Table 2 and Table S2 ). In analyses of SEER and California Cancer Registry data, patients of all ages with gastric cancer residing in rural areas were also less likely to receive surgery compared to those in urban areas, which was attributed to lower levels of educational attainment, lower median household income, longer commute times, less contact with oncology providers, and less access to health insurance [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Variation in Treatment Patterns of Patients with Early-Onset Gastric Cancer

LaPelusa

Shen

Gillaspie

et al. 2022

Cancers

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Background: Early-onset gastric cancer (EOGC), or gastric cancer in patients younger than 45 years old, is poorly understood and relatively uncommon. Similar to other gastrointestinal malignancies, the incidence of EOGC is rising in Western countries. It is unclear which populations experience a disproportionate burden of EOGC and what factors influence how patients with EOGC are treated. Methods: We conducted a retrospective, population-based study of patients diagnosed with gastric cancer from 2004 to 2018 using the National Cancer Database (NCDB). In addition to identifying unique demographic characteristics of patients with EOGC, we evaluated (using multivariable logistic regression controlling for year of diagnoses, primary site, and stage) how gender/sex, race/ethnicity, treatment facility type, payor status, and location of residence influenced the receipt of surgery, chemotherapy, and radiation. Results: Compared to patients 45–70 and >70 years of age with gastric cancer, patients with EOGC were more likely to be female, Asian/Pacific Islander (PI), African American (AA), Hispanic, uninsured, and present with stage IV disease. On multivariable analysis, several differences among subsets of patients with EOGC were identified. Female patients with EOGC were less likely to receive surgery and chemotherapy than male patients with EOGC. Asian/Pacific Islander patients with EOGC were more likely to receive chemotherapy and less likely to receive radiation than Caucasian patients with EOGC. African American patients were more likely to receive chemotherapy than Caucasian patients with EOGC. Hispanic patients were more likely to receive surgery and chemotherapy and less likely to receive radiation than Caucasian patients with EOGC. Patients with EOGC treated at community cancer centers were more likely to receive surgery and less likely to receive chemotherapy than patients with EOGC treated at academic centers. Uninsured patients with EOGC were more likely to receive surgery and less likely to receive chemotherapy than privately insured patients with EOGC. Patients with EOGC living in locations not adjacent to metropolitan areas were less likely to receive surgery compared to patients with EOGC who resided in metropolitan areas, Conclusions: Patients with EOGC are a demographically distinct population. Treatment of these patients varies significantly based on several demographic factors. Additional analysis is needed to elucidate why particular groups are more affected by EOGC and how treatment decisions are made for, and by, these patients.

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Urban–Rural Variations in Quality of Care Among Patients With Cancer in California

Cited by 13 publications

References 47 publications

Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

Rural–Urban Disparities in Patient Care Experiences among Prostate Cancer Survivors: A SEER-CAHPS Study

Characteristics Associated With Mexican-American Hospice Use: Retrospective Cohort Study Using the Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE)

Variation in Treatment Patterns of Patients with Early-Onset Gastric Cancer

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