ASPO Abstracts

Rural-Urban Disparities in Pancreatic Cancer Stage of Diagnosis: Understanding the Interaction with Medically Underserved Areas

Authors: Segel JE; Hollenbeak CS; Gusani NJ

Category: Cancer Health Disparities
Conference Year: 2020

Abstract Body:
Purpose To estimate differences in stage of pancreatic cancer diagnosis by rurality of patient residence and residence in a medically underserved area (MUA). Methods Using 2010-2015 Pennsylvania Cancer Registry data, we restrict our analysis to adults diagnosed with pancreatic cancer. Using Rural Urban Continuum Codes (RUCC) we categorize each patient’s residence as: (1) metro; (2) non-metro adjacent with population ≥ 20,000; (3) non-metro adjacent with population < 20,000; (4) non-metro non-adjacent, and (5) completely rural; as well as whether the county was a full MUA, partial MUA, or non-MUA. We examine the percent of patients diagnosed with local and locoregional stage of disease for each residential rurality and MUA status grouping. We estimate multivariate linear probability models of local and locoregional stage of diagnosis while controlling for demographics, insurance type, year, rurality, and MUA status. Finally, we estimate models interacting rurality with MUA status to disentangle the relative impact of each on stage of diagnosis. Results We find that no pancreatic cancer patients living in completely rural areas were diagnosed at the local stage, the lowest of all categories of rurality. In adjusted models, we find that patients living in completely rural areas have significantly lower rates of local (9.7 percentage points lower relative to metro areas; 95% CI: 1.2 to 18.1 percentage points lower) and local/regional stage of diagnosis (20.6 percentage points lower relative to metro areas; 95% CI: 6.4 to 34.9 percentage points lower). The estimates are attenuated slightly when controlling for MUA. Finally, we find that patients living in full MUA have lower rates of local and locoregional stage of diagnosis even when controlling for rurality of residence. Conclusions We find significantly lower rates of early stage pancreatic cancer diagnosis for patients living in completely rural areas. While lack of primary medical care resources is an important factor, rural residence remains an important independent predictor in later stage of diagnosis.

Keywords: rural-urban disparities; diagnostic stage