Rural Reversal? Rural-urban Disparities in Late-Stage Cancer Risk in Illinois

Cancer. 2009 Jun 15;115(12):2755-64. doi: 10.1002/cncr.24306.

Abstract

Background: Differences in late-stage cancer risk between urban and rural residents are a key component of cancer disparities. Using data from the Illinois State Cancer Registry from 1998 through 2002, the authors investigated the rural-urban gradient in late-stage cancer risk for 4 major types of cancer: breast, colorectal, lung, and prostate.

Methods: Multilevel modeling was used to evaluate the role of population composition and area-based contextual factors in accounting for rural-urban variation. Instead of a simple binary rural-urban classification, a finer grained classification was used that differentiated the densely populated City of Chicago from its suburbs and from smaller metropolitan areas, large towns, and rural settings.

Results: For all 4 cancers, the risk was highest in the most highly urbanized area and decreased as rurality increases, following a J-shaped progression that included a small upturn in risk in the most isolated rural areas. For some cancers, these geographic disparities were associated with differences in population age and race; for others, the disparities remained after controlling for differences in population composition, zip code socioeconomic characteristics, and spatial access to healthcare.

Conclusions: The observed pattern of urban disadvantage emphasized the need for more extensive urban-based cancer screening and education programs.

Publication types

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

MeSH terms

  • Aged
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / pathology
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / pathology
  • Early Detection of Cancer
  • Female
  • Health Services Accessibility
  • Humans
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Neoplasms / epidemiology
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / pathology
  • Risk Factors
  • Rural Population
  • Socioeconomic Factors
  • Urban Population