Geographic Disparities Found in Cancer Diagnosis Stage, Mortality for AYAs
Dec 19, 2023
For adolescents and young adults (AYAs) with cancer, living in rural counties and living farther from the reporting hospital are associated with later-stage diagnoses and increased mortality, according to a study published online July 8 in Cancer. Kimberly J. Johnson, M.P.H., Ph.D., from Washington University in St. Louis, and colleagues obtained data on AYAs aged 15 to 39 years who were diagnosed with cancer from 2010 to 2014. Residence in metropolitan (metro), urban, or rural counties was defined at the time of diagnosis. The distance between the patient’s residence and the reporting hospital was classified as short, intermediate, or long. The stage analysis included 146,418 AYAs, while the survival analysis included 178,688 AYAs. The researchers found that the odds of having a late versus early stage at diagnosis (stages III and IV versus I and II) were increased for those living in rural versus metro counties and for those living at long versus short distances to the reporting hospital (odds ratios, 1.16 and 1.20, respectively). The risk for death was increased for those living in rural versus metro counties and for long versus short distances to the reporting hospital (hazard ratios, 1.17 and 1.30, respectively). Of the associations between metro, urban, or rural residence and residential distance categories and survival, 54 and 31 percent, respectively, was mediated by disease stage.
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