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. 2025 May;42(Suppl 2):S22-S29b.
doi: 10.12788/fp.0560. Epub 2025 May 8.

Colorectal Cancer Characteristics and Mortality From Propensity Score-Matched Cohorts of Urban and Rural Veterans

Minh Anh Le  1 , Po-Hong Liu  2 , Amar Mandalia  3 , Sergio Romero  4 , Ishak A Mansi  1   3 , Moheb Boktor  2
Affiliations

Colorectal Cancer Characteristics and Mortality From Propensity Score-Matched Cohorts of Urban and Rural Veterans

Minh Anh Le et al. Fed Pract. 2025 May.

Abstract

Background: Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths in the United States. Rural living poses special challenges to CRC screening and management, but it is unclear whether rural/urban disparities persist within the Veterans Health Administration (VHA).

Methods: This study used VHA data to examine characteristics and mortality among veterans with newly diagnosed CRC. Urban areas were defined using Rural Urban Commuting Area categories 1.0 and 1.1; all other areas were classified as rural. Propensity score-matching analysis was used to address differences in baseline characteristics and compare mortality between rural and urban veterans with CRC. An additional propensity score-matching analysis focused on CRC among veterans aged ≤ 45 years.

Results: Of 2,460,727 individuals, there were 19,422 urban and 10,797 rural veterans with CRC (fiscal years 2016-2021). In rural areas, 83.6% of patients with CRC were White, compared to 67.8% in urban areas. Veterans with CRC in rural areas were also older, more likely to be obese, but had a lower Charlson Comorbidity Index (all P < .05). In the propensity score-matched cohort, baseline demographics and comorbidities were similar between rural and urban CRC patients. Total mortality occurred in 3702 urban veterans (34.3%) and 3763 rural veterans (34.9%) (hazard ratio [HR], 1.01; 95% CI, 0.97-1.06, P = .53). More patients with CRC were aged ≤ 45 years in urban areas (n = 391, 2.0%) than in rural areas (n = 160, 1.5%; P = .001), and their mortality was similar in the propensity score-matched group (HR, 0.97; 95% CI, 0.57-1.63).

Conclusions: Veterans with CRC in rural or urban areas had similar survival outcomes. The study implies that an integrated health system may help alleviate disparities between rural and urban America.

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Conflict of interest statement

Author disclosures: The authors report no actual or potential conflicts of interest with regard to this article.

Figures

FIGURE 1
FIGURE 1
Veterans With Newly Diagnosed Colorectal Cancer by Rurality
FIGURE 2
FIGURE 2
Kaplan-Meier Failure Estimates of Colorectal Cancer Death for Propensity Score-Matched Cohorts
FIGURE 3
FIGURE 3
Kaplan-Meier Failure Estimates of Colorectal Cancer Death by Race
FIGURE 4
FIGURE 4
Kaplan-Meier Failure Estimates of Colorectal Cancer Death Between Rural and Urban Veterans by Sex and Ethnicity
See this image and copyright information in PMC

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