Rural‐urban disparities in health status among US cancer survivors

BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban disparities in self‐reported health among survivors. METHODS: The authors identified adults who had a self‐reported history of cancer from the Natio...

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Published in:	Cancer Vol. 119; no. 5; pp. 1050 - 1057
Main Authors:	Weaver, Kathryn E., Geiger, Ann M., Lu, Lingyi, Case, L. Douglas
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2013 Wiley-Blackwell
Subjects:	Aged Aged, 80 and over Biological and medical sciences cancer comorbidity Epidemiology Female Health Status Health Status Disparities Humans Male Medical sciences mental health Middle Aged Neoplasms - psychology rural health Rural Population survivors Survivors - psychology Tumors unemployment United States - epidemiology United States North America America USA Human Rural environment Socioeconomic status Survivor Mental health health status disparities Malignant tumor Unemployment Concomitant disease Cancerology Health status comorbidity survivors Disparity rural health Public health Cancer
ISSN:	0008-543X, 1097-0142, 1097-0142
Online Access:	Get full text
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Abstract	BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban disparities in self‐reported health among survivors. METHODS: The authors identified adults who had a self‐reported history of cancer from the National Health Interview Survey (2006‐2010). Rural‐urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural‐urban differences in health status after accounting for differences in demographic characteristics. RESULTS: Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non‐Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20‐1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00‐1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01‐1.32), and health‐related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35‐2.03). CONCLUSIONS: The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Cancer 2013. © 2012 American Cancer Society. There are an estimated 2.8 million cancer survivors who reside in rural areas of the United States. Relative to urban survivors, rural survivors report poorer health, higher psychological distress, more noncancer comorbidities, and higher rates of health‐related unemployment.
AbstractList	BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban disparities in self‐reported health among survivors. METHODS: The authors identified adults who had a self‐reported history of cancer from the National Health Interview Survey (2006‐2010). Rural‐urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural‐urban differences in health status after accounting for differences in demographic characteristics. RESULTS: Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non‐Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20‐1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00‐1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01‐1.32), and health‐related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35‐2.03). CONCLUSIONS: The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Cancer 2013. © 2012 American Cancer Society. There are an estimated 2.8 million cancer survivors who reside in rural areas of the United States. Relative to urban survivors, rural survivors report poorer health, higher psychological distress, more noncancer comorbidities, and higher rates of health‐related unemployment. BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors. METHODS: The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics. RESULTS: Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), greater than or equal to 2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03). CONCLUSIONS: The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Cancer 2013. [copy 2012 American Cancer Society. There are an estimated 2.8 million cancer survivors who reside in rural areas of the United States. Relative to urban survivors, rural survivors report poorer health, higher psychological distress, more noncancer comorbidities, and higher rates of health-related unemployment. Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors. The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics. Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03). The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being. Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors.BACKGROUNDAlthough rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors.The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics.METHODSThe authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics.Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03).RESULTSOf the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03).The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being.CONCLUSIONSThe current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being.
Author	Lu, Lingyi Geiger, Ann M. Case, L. Douglas Weaver, Kathryn E.
AuthorAffiliation	2 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem NC 27157 1 Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem NC 27157 3 Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC 27157
AuthorAffiliation_xml	– name: 2 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem NC 27157 – name: 3 Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem NC 27157 – name: 1 Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem NC 27157
Author_xml	– sequence: 1 givenname: Kathryn E. surname: Weaver fullname: Weaver, Kathryn E. email: keweaver@wakehealth.edu – sequence: 2 givenname: Ann M. surname: Geiger fullname: Geiger, Ann M. – sequence: 3 givenname: Lingyi surname: Lu fullname: Lu, Lingyi – sequence: 4 givenname: L. Douglas surname: Case fullname: Case, L. Douglas
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Keywords	Human Rural environment Socioeconomic status Survivor Mental health health status disparities Malignant tumor Unemployment Concomitant disease Cancerology Health status comorbidity survivors Disparity rural health Public health Cancer
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Notes	The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Research Data Center, the National Center for Health Statistics, or the Centers for Disease Control and Prevention. Fax: (336) 716‐7554 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
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Snippet	BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural‐urban... Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in... BACKGROUND: Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban...
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SubjectTerms	Aged Aged, 80 and over Biological and medical sciences cancer comorbidity Epidemiology Female Health Status Health Status Disparities Humans Male Medical sciences mental health Middle Aged Neoplasms - psychology rural health Rural Population survivors Survivors - psychology Tumors unemployment United States - epidemiology
Title	Rural‐urban disparities in health status among US cancer survivors
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