ArticleJournal of the National Cancer Institute2023
Defining rurality: an evaluation of rural definitions and the impact on survival estimates.
Article in Journal of the National Cancer Institute, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- A Novel Telehealth Exercise Program Designed for Rural Survivors of Cancer With Cancer-Related Fatigue: Single-Arm Feasibility Trial.JMIR cancer · 2025Trial
- Cancer Risk Factors, Screening, and Neighborhood Socioeconomic Deprivation Across the U.S. Urban-to-Frontier Continuum.Journal of the National Cancer Institute. Monographs · 2026Article
- Survival improvement and widening social disadvantage-related disparities in osteosarcoma: a Surveillance, Epidemiology, and End Results-based retrospective cohort study.Translational cancer research · 2026Article
- Individual and combined effects of marital status, household income, and residence on cancer management and survival in primary bone cancer: a SEER-based retrospective cohort study.Translational cancer research · 2026Article
- Determinants of incidence trends in pancreatic neuroendocrine neoplasms.Journal of neuroendocrinology · 2026Article
- Rural residence and mental health among US Veterans: Findings from the Millennium Cohort Study.PloS one · 2026Article
- Mapping the landscape of rural cancer research: a global bibliometric analysis.Cancer causes & control : CCC · 2025Review
- Identifying Measures for Understanding and Addressing County-Level Disparities in Adolescent HPV Vaccination Coverage in North Carolina.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Article
- Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach.Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025Article
- Contribution of County Characteristics to Disparities in Rural Mortality After Cancer Diagnosis.American journal of preventive medicine · 2024Article
- Estimating the Impact of Rurality in Disparities in Cancer Mortality.JCO oncology practice · 2024Article
- Why location matters: associations between county-level characteristics and availability of National Cancer Oncology Research Program and National Cancer Institute sites.JNCI cancer spectrum · 2024Article
- Urban-rural differences in cancer mortality: Operationalizing rurality.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2024Article
- Comparison of US Oncologist Rurality by Practice Setting and Patients Served.JAMA network open · 2024Article
- An essential goal within reach: attaining diversity, equity, and inclusion for the Journal of the National Cancer Institute journals.JNCI cancer spectrum · 2023Article
- A Scoping Review and Assessment of the Area-Level Composite Measures That Estimate Social Determinants of Health Across the United States.Public health reports (Washington, D.C. : 1974)Article
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4 authors.
Funding
Abstract
backgroundPatients with cancer living in rural areas have inferior cancer outcomes; however, studies examining this association use varying definitions of "rural," complicating comparisons and limiting the utility of the results for policy makers and future researchers.
methodsSurveillance, Epidemiology, and End Results data (2000-2016) were used to assess risk of cancer mortality and mortality from any cause across 4 definitions of rurality: Urban Influence codes (UIC), National Center for Health Statistics (NCHS), Rural-Urban continuum codes (RUCC), and Index of Relative Rurality. Binary (urban vs rural) and ternary (urban, micropolitan, rural) definitions were evaluated. Multivariable parametric survival models estimated hazards of mortality overall and among 3 cancer groupings: screening related, obesity related, and tobacco related. Definition agreement was also assessed.
resultsOverall, 3 788 273 patients with an incident cancer representing 605 counties were identified. There was little discordance between binary definitions of rural vs urban and moderate agreement at the 3 levels. Adjusted models using binary definitions revealed 15% to 17% greater hazard of cancer mortality in rural compared with urban. At the 3 levels when comparing rural with metropolitan, RUCC and NCHS saw similarly increased hazard ratios; however, Index of Relative Rurality did not. Screening-related cancers saw the highest hazards of mortality and the largest divergence between definitions. Obesity-related and tobacco-related cancers saw similarly increased hazards of mortality at the binary and ternary levels.
conclusionsHazard of death is similar across binary definitions; however, this differed when categorized as ternary or continuous, especially among screening-related cancers. Results suggest that study purpose should direct choice of definitions and categorization.
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