Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112053

Lisa R. Shugarman, PhD¹, Melony E.S. Sorbero, PhD¹, Haijun Tian², Arvind Jain, MS³, and Scott Ashwood⁴. (1) RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401-2138, 310-393-0411, x.7701, Lisa_Shugarman@rand.org, (2) Pardee RAND Graduate School, 1776 Main Street, PO Box 2138, Santa Monica, CA 90401-2138, (3) Statistics Group, RAND Corporation, 1200 South Hayes St., Arlington, VA 22202, (4) RAND, 201 North Craig Street, Suite 202, Pittsburgh, PA 15213

Little is known about urban/rural differences in the outcomes and quality of care for cancer patients in the United States, even though there is a large literature exploring the relationship of selected socio-demographic characteristics (e.g., gender, age, race, income or socio-economic status) to cancer incidence, quality of care and outcomes. Using Surveillance, Epidemiology, and End Results (SEER) data merged with Medicare claims, we examine a series of models testing hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries age 65 and older diagnosed with lung cancer between 1995 and 1999 (N=35,195). An examination of the Kaplan Meier curves stratified by urban/rural residence reveals that rural residents have a worse mortality experience (i.e., lower curve) compared to urban and metropolitan-residing Medicare beneficiaries. However, after building proportional hazards regression models and adjusting for demographics (age, gender, and race), enabling and need characteristics (marital status, neighborhood poverty, median household income, proportion of neighborhood capable of speaking English, stage at diagnosis, number of comorbidities) as well as treatment variables (received chemotherapy, radiation, and/or surgery), rural beneficiaries' risk of mortality is not significantly different from that for urban or metropolitan-residing beneficiaries. Demographic and clinical characteristics more strongly influence survival than any other variables in the model. These findings suggest that geographic residence does not influence survival outcomes of lung cancer, a condition with a poor prognosis. Further research will explore whether there are differences in timing of diagnosis and treatment type between these geographic populations.

Learning Objectives:

At the conclusion of the session, the participant will be able to
• list the factors associated with outcomes for Medicare beneficiaries with lung cancer and
• discuss the relationship between urban/rural residence and survival outcomes for this population.

Keywords: Rural Health Care, Medicare

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.