Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 7;4(4):pkaa011.
doi: 10.1093/jncics/pkaa011. eCollection 2020 Aug.

Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State

Kathleen M Fairfield  1 , Adam W Black  1 , Erika C Ziller  2 , Kimberly Murray  1 , F Lee Lucas  1 , Leo B Waterston  1 , Neil Korsen  1 , Darlene Ineza  3 , Paul K J Han  1
Affiliations

Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State

Kathleen M Fairfield et al. JNCI Cancer Spectr. .

Abstract

Background: We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality.

Methods: We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System.

Results: Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79).

Conclusion: Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Relationship between rurality and area deprivation index across person-years, in thousands.
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A.. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7–34. - PubMed
    1. Henley SJ, Anderson RN, Thomas CC, Massetti GM, Peaker B, Richardson LC.. Invasive cancer incidence, 2004-2013, and deaths, 2006-2015, in nonmetropolitan and metropolitan counties—United States. MMWR Surveill Summ. 2017;66(14):1–13. - PMC - PubMed
    1. Meilleur A, Subramanian SV, Plascak JJ, Fisher JL, Paskett ED, Lamont EB.. Rural residence and cancer outcomes in the United States: issues and challenges. Cancer Epidemiol Biomarkers Prev. 2013;22(10):1657–1667. - PMC - PubMed
    1. Zahnd WE, Fogleman AJ, Jenkins WD.. Rural-urban disparities in stage of diagnosis among cancers with preventive opportunities. Am J Prev Med. 2018;54(5):688–698. - PubMed
    1. Doogan NJ, Roberts ME, Wewers ME, et al. A growing geographic disparity: rural and urban cigarette smoking trends in the United States. Prev Med. 2017;104:79–85. - PMC - PubMed

LinkOut - more resources