Journal
JOURNAL OF RURAL HEALTH
Volume 36, Issue 4, Pages 484-495Publisher
WILEY
DOI: 10.1111/jrh.12429
Keywords
early-stage; late-stage; lung cancer; rural; veterans
Categories
Funding
- Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health [N32-FY16Q1-S1-P01577]
- Veterans Rural Health Resource Center
- Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center [CIN 13-412]
- University of Iowa Holden Comprehensive Cancer Center [PO30 CA086862]
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Purpose To evaluate the association between rurality and lung cancer stage at diagnosis. Methods We conducted a cross-sectional study using Veterans Health Administration (VHA) data to identify veterans newly diagnosed with lung cancer between October 1, 2011 and September 30, 2015. We defined rurality, based on place of residence, using Rural-Urban Commuting Area (RUCA) codes with the subcategories of urban, large rural, small rural, and isolated. We used multivariable logistic regression models to determine associations between rurality and stage at diagnosis, adjusting for sociodemographic and clinical characteristics. We also analyzed data using the RUCA code for patients' assigned primary care sites and driving distances to primary care clinics and medical centers. Findings We identified 4,220 veterans with small cell lung cancer (SCLC) and 25,978 with non-small cell lung cancer (NSCLC). Large rural residence (compared to urban) was associated with early-stage diagnosis of NSCLC (OR = 1.12; 95% CI: 1.00-1.24) and SCLC (OR = 1.73; 95% CI: 1.18-1.55). However, the finding was significant only in the southern and western regions of the country. White race, female sex, chronic lung disease, higher comorbidity, receiving primary care, being a former tobacco user, and more recent year of diagnosis were also associated with diagnosing early-stage NSCLC. Driving distance to medical centers was inversely associated with late-stage NSCLC diagnoses, particularly for large rural areas. Conclusions We did not find clear associations between rurality and lung cancer stage at diagnosis. These findings highlight the complex relationship between rurality and lung cancer within VHA, suggesting access to care cannot be fully captured by current rurality codes.
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