An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries

Am J Public Health. 2008 Jul;98(7):1280-7. doi: 10.2105/AJPH.2006.099416. Epub 2007 Oct 30.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / rehabilitation*
  • Male
  • Medicare / statistics & numerical data*
  • Multivariate Analysis
  • Patient Satisfaction / statistics & numerical data
  • Primary Health Care / statistics & numerical data
  • Retrospective Studies
  • Rural Population / statistics & numerical data*
  • Survival Analysis
  • Survivors / statistics & numerical data*
  • United States / epidemiology
  • Urban Population / statistics & numerical data*