Racial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER)

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Author(s)Lewis-Thames, Marquita W.
Author(s)Langston, Marvin E.
Author(s)Khan, Saira
Date Accessioned2023-09-28T15:43:28Z
Date Available2023-09-28T15:43:28Z
Publication Date2022-03-14
DescriptionThis article was originally published in Jama Network Open. The version of record is available at: https://doi.org/10.1001/JAMANETWORKOPEN.2022.12246. © 2022 Lewis-Thames MW et al. JAMA Network Open.
AbstractKey Points Question What are the rural-urban trends in overall and cancer-specific survival across the most prevalent cancer types (ie, lung, prostate, breast, and colorectal cancers)? Findings This cross-sectional study of 3 659 417 patients with cancer used an epidemiological assessment of 1975 to 2011 data from the SEER database and found that 5-year cancer-specific survival trends were often lower for rural and non-Hispanic Black patients. Meaning These findings suggest that the survival of rural patients has trailed the survival of urban patients for almost 40 years, regardless of sociodemographic and clinical variables. Abstract Importance Considering reported rural-urban cancer incidence and mortality trends, rural-urban cancer survival trends are important for providing a comprehensive description of cancer burden. Furthermore, little is known about rural-urban differences in survival trends by racial and ethnic groups. Objective To examine national rural-urban trends in 5-year cancer-specific survival probabilities for lung, prostate, breast, and colorectal cancers in a diverse sample of racial and ethnic groups. Design, Setting, and Participants This cross-sectional study used an epidemiologic assessment with 1975 to 2016 Surveillance, Epidemiology, and End Results (SEER) data to analyze patients diagnosed no later than 2011. Patients were classified as living in rural and urban counties based on the 2013 Rural-Urban Continuum Codes. Main Outcomes and Measures The 5-year cancer-specific survival probability of urban and rural patients for each cancer type was estimated by fitting Cox proportional hazard regression models accounting for race, ethnicity, tumor characteristics, and other sociodemographic characteristics. A generalized linear regression model was used to estimate the mean estimated probability of survival for each stratum. Joinpoint regression analysis estimated periods of significant change in survival. Results In this study, data from 3 659 417 patients with cancer (median [IQR] age, 67 [58-76]; 1 918 609 [52.4%] male; 237 815 [6.5%] Hispanic patients; 396 790 [10.8%] Black patients; 2 825 037 [77.2%] White patients) were analyzed, including 888 338 patients with lung cancer (24.3%), 750 704 patients with colorectal cancer (20.5%), 987 826 patients with breast cancer (27.0%), and 1 023 549 patients with prostate cancer (28.0%). There were 430 353 rural patients (11.8%). Overall, there was an equal representation of rural and urban men. Rural patients were likely to be non-Hispanic White individuals, have more cases of distant tumors, and be older. Rural and non-Hispanic Black patients for all cancer types often had shorter survival. From 1975 to 2016, the 5-year lung cancer survival rate was shorter for non-Hispanic Black rural patients in 1975 at 48%, while increasing to 57% for both non-Hispanic Black urban and rural patients in 2011, but still the shortest among all cancer types. In 1975, the longest survival rate was observed in urban Asian and Pacific Islander patients with breast cancer at 86%, and in 2011, the longest survival rate was observed in urban non-Hispanic White patients at 92%. Conclusions and Relevance Even after accounting for sociodemographic and tumor characteristics, these findings suggest that non-Hispanic Black patients with cancer are particularly vulnerable to cancer burden, and resources are urgently needed to reverse decades-old survival trends.
SponsorConflict of Interest Disclosures: Dr Khan reported receiving grants from the US Department of Defense outside the submitted work. No other disclosures were reported. Funding/Support: Dr Lewis-Thames was supported grant UL1TR001422 from the Northwestern University Clinical and Translational Sciences Institute, grant RHA2020-01 Respiratory Health Association of Metropolitan Chicago, grant K01CA262342 from the National Cancer Institute, grant P30AG059988 from the National Institutes of Health's National Institute on Aging, and funds from the Northwestern University Center for Community Health. Dr Khan was supported by grant W81XWH-18-1-0168 from US the Department of Defense Prostate Cancer Research Program. Dr Moore was supported by grant K01MD015304 from the National Institute on Minority Health and Health Disparities of the National Institutes of Health. Dr Langston was supported by grant K12DK111028 from the National Institute of Diabetes and Digestive and Kidney of the National Institutes of Health. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
CitationLewis-Thames MW, Langston ME, Khan S, et al. Racial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER). JAMA Netw Open. 2022;5(5):e2212246. doi:10.1001/jamanetworkopen.2022.12246
ISSN2574-3805
URLhttps://udspace.udel.edu/handle/19716/33338
Languageen_US
PublisherJama Network Open
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
Keywordsgood health and well-being
TitleRacial and Ethnic Differences in Rural-Urban Trends in 5-Year Survival of Patients With Lung, Prostate, Breast, and Colorectal Cancers: 1975-2011 Surveillance, Epidemiology, and End Results (SEER)
TypeArticle
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