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Keywords:

  • neoplasms;
  • health disparities;
  • stage at diagnosis;
  • rural

Abstract

BACKGROUND:

Differences in late-stage cancer risk between urban and rural residents are a key component of cancer disparities. Using data from the Illinois State Cancer Registry from 1998 through 2002, the authors investigated the rural-urban gradient in late-stage cancer risk for 4 major types of cancer: breast, colorectal, lung, and prostate.

METHODS:

Multilevel modeling was used to evaluate the role of population composition and area-based contextual factors in accounting for rural-urban variation. Instead of a simple binary rural-urban classification, a finer grained classification was used that differentiated the densely populated City of Chicago from its suburbs and from smaller metropolitan areas, large towns, and rural settings.

RESULTS:

For all 4 cancers, the risk was highest in the most highly urbanized area and decreased as rurality increases, following a J-shaped progression that included a small upturn in risk in the most isolated rural areas. For some cancers, these geographic disparities were associated with differences in population age and race; for others, the disparities remained after controlling for differences in population composition, zip code socioeconomic characteristics, and spatial access to healthcare.

CONCLUSIONS:

The observed pattern of urban disadvantage emphasized the need for more extensive urban-based cancer screening and education programs. Cancer 2009. © 2009 American Cancer Society.