Evidence map›Paper›PMID 39419275›Full record

ArticleJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract2025

Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach.

Crisanto M Torres, Sara Myers, Megan G Janeway, Sabrina E Sanchez, Dane R Scantling, Elizabeth S Davis, Sing Chau Ng, Tracey Dechert, Teviah E Sachs, Kelly M Kenzik

Abstract readComparative Study
In one paragraph

Article in Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Crisanto M TorresDivision of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States. Electronic address: crtorres@bu.edu.
Sara MyersDepartment of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Megan G JanewayDivision of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Sabrina E SanchezDivision of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Dane R ScantlingDivision of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Elizabeth S DavisDepartment of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Sing Chau NgDepartment of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Tracey DechertDivision of Trauma and Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
Teviah E SachsDepartment of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Surgical Oncology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States.
Kelly M KenzikDepartment of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.

Funding

Understanding rural mortality disparities in cancer: a multi-level approachR37CA266193 · NCI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI KELLY KENZIK · 2022 to 2026
$1.8M
NCI NIH HHS HHSN261201800009CNCI NIH HHS HHSN261201800009INCI NIH HHS HHSN261201800015CNCI NIH HHS HHSN261201800015INCI NIH HHS HHSN261201800032CNCI NIH HHS HHSN261201800032INCI NIH HHS R37 CA266193
6 · The paper itself

Abstract

backgroundRural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents.

methodsThis retrospective study included adult patients captured in the Surveillance, Epidemiology, and End Results-Medicare data between January 2008 and December 2015 with an incident stage I to IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was a nonelective cancer-directed surgery among rural vs urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering.

resultsThe sample included 10,136 patients who underwent a surgical intervention; 2941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural than urban patients (351 [27%] and 2590 [29%]; P = .05). There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents (odds ratio, 0.88; 95% CI, 0.76-1.03; P = .11; adjusted odds ratio [aOR], 0.86; 95% CI, 0.72-1.02; P = .080). In addition, high social vulnerability index (SVI) counties or Black race was significantly associated with increase odds of nonelective surgery (aOR, 1.33; 95% CI, 1.07-1.65; P = .009; aOR, 1.49; 95% CI, 1.26-1.77; P < .0001, respectively).

conclusionThis study found no difference in the odds of receiving nonelective surgery for gastrointestinal foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore whether disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

Indexed as

Healthcare DisparitiesRural PopulationSEER ProgramUrban PopulationAgedAged, 80 and overDigestive System Surgical ProceduresFemaleHumansLogistic ModelsMaleRetrospective StudiesUnited StatesEmergency surgeryInequitiesNonelective surgeryRural outcomesRural-urban disparity

Identifiers

PMID39419275
PMCPMC12212428

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.