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The impact of rural residence on adult brain cancer survival in the United States

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Abstract

Purpose

Rural/urban disparities in brain cancer survival have been reported. However, disparities by cancer type or in the United States as a whole remain poorly understood. Using the Surveillance, Epidemiology, and End Results (SEER) 18 registries database, we examined brain cancer survival by rural/urban residence defined by Rural–Urban Continuum Codes (RUCCs).

Methods

We obtained data from SEER 18 registries for individuals aged 20 years and older with a first primary malignant brain cancer from 2001 to 2011. Rural/urban residence at diagnosis was defined using both metropolitan/non-metropolitan county classifications and individual RUCC categories. We used Cox proportional hazards regression to compute adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between rural/urban residence and brain cancer survival.

Results

Among 37,581 cancer cases, 77.9% were non-Hispanic White, 56.5% were male, and 88.7% lived in a metropolitan county. Brain cancer patients living in the most rural counties had a significant increased risk of cancer death compared to those living in the most urban counties (HR 1.15; 95% CI 1.01–1.31). Those living in non-metropolitan counties had a similar risk of cancer death compared to those living in metropolitan counties (HR 1.01; 95% CI 0.97–1.06). Effect modification was observed overall by cancer type, with non-specified oligodendroglioma (HR 1.35; 95% CI 1.01–1.81) showing the greatest effect.

Conclusion

After adjusting for confounding factors, our results suggest that rural residence has a modest effect on brain cancer survival, and that this disparity may vary by cancer type. Future research should explore differences in treatment strategies between rural and urban brain cancer patients.

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Authors and Affiliations

  1. Department of Neurosurgery, University of California, San Diego, La Jolla, USA

    Arash Delavar, Omar M. Al Jammal, Kathleen R. Maguire, Arvin R. Wali & Martin H. Pham

  2. Department of Neurosurgery, UC San Diego Health, 9300 Campus Point Drive, MC7893, La Jolla, CA, 92037, USA

    Martin H. Pham

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Delavar, A., Al Jammal, O.M., Maguire, K.R. et al. The impact of rural residence on adult brain cancer survival in the United States. J Neurooncol 144, 535–543 (2019). https://doi.org/10.1007/s11060-019-03254-4

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