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AJPH First Look, published online ahead of print Oct 30, 2007
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July 2008, Vol 98, No. 7 | American Journal of Public Health 1280-1287
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2006.099416

RESEARCH AND PRACTICE

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

Lisa R. Shugarman, PhD, Melony E.S. Sorbero, PhD, Haijun Tian, PhD, Arvind K. Jain, MS and J. Scott Ashwood, MA

Lisa R. Shugarman is with the RAND Corporation, Santa Monica, Calif. Melony E. S. Sorbero and J. Scott Ashwood are with the RAND Corporation, Pittsburgh, Pa. At the time of the study, Haijun Tian was a graduate student in the Pardee RAND Graduate School, Santa Monica. Arvind K. Jain is with the RAND Corporation, Arlington, Va.

Correspondence: Requests for reprints should be sent to Dr Lisa R. Shugarman, RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138 (e-mail: lisas{at}rand.org).

Objectives. We 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. We 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. We 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.






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