Cover: An Exploration of Urban and Rural Differences in Lung Cancer Survival Among Medicare Beneficiaries

An Exploration of Urban and Rural Differences in Lung Cancer Survival Among Medicare Beneficiaries

Published in: American journal of public health, v. 98, no. 7, July 1, 2008, p. 1280-1287

Posted on 2008

by Lisa R. Shugarman, Melony E. Sorbero, Haijun Tian, Arvind Jain, J. Scott Ashwood

OBJECTIVES: The authors tested the relationship between urban or rural residence as defined by rural-urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer. METHODS: They used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073). RESULTS: The authors found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract-level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality. CONCLUSIONS: Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries' potential disadvantage when it comes to receiving needed care in a timely fashion.

This report is part of the RAND external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.