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      Urban relatives ameliorate survival disparities for genitourinary cancer in rural patients

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          Abstract

          Introduction

          Patients living in rural areas have worse cancer‐specific outcomes. This study examines the effect of family‐based social capital on genitourinary cancer survival. We hypothesized that rural patients with urban relatives have improved survival relative to rural patients without urban family.

          Methods

          We examined rural and urban based Utah individuals diagnosed with genitourinary cancers between 1968 and 2018. Familial networks were determined using the Utah Population Database. Patients and relatives were classified as rural or urban based on 2010 rural–urban commuting area codes. Overall survival was analyzed using Cox proportional hazards models.

          Results

          We identified 24,746 patients with genitourinary cancer with a median follow‐up of 8.72 years. Rural cancer patients without an urban relative had the worst outcomes with cancer‐specific survival hazard ratios (HRs) at 5 and 10 years of 1.33 (95% CI 1.10–1.62) and 1.46 (95% CI 1.24–1.73), respectively relative to urban patients. Rural patients with urban first‐degree relatives had improved survival with 5‐ and 10‐year survival HRs of 1.21 (95% CI 1.06–1.40) and 1.16 (95% CI 1.03–1.31), respectively.

          Conclusions

          Our findings suggest rural patients who have been diagnosed with a genitourinary cancer have improved survival when having relatives in urban centers relative to rural patients without urban relatives. Further research is needed to better understand the mechanisms through which having an urban family member contributes to improved cancer outcomes for rural patients. Better characterization of this affect may help inform policies to reduce urban–rural cancer disparities.

          Abstract

          Patients living in rural areas have worse overall survival and cancer‐specific outcomes. This study examines the effect of family‐based social capital on genitourinary cancer survival. We hypothesized that rural patients with urban relatives have improved survival relative to rural patients without urban family.

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          Most cited references15

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          Exposing some important barriers to health care access in the rural USA

          To review research published before and after the passage of the Patient Protection and Affordable Care Act (2010) examining barriers in seeking or accessing health care in rural populations in the USA.
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            Rural-Urban Differences in Cancer Incidence and Trends in the United States

            Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends.Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.
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              Making the Case for Investment in Rural Cancer Control: An Analysis of Rural Cancer Incidence, Mortality, and Funding Trends

              Estimates of those living in rural counties vary from 46.2–59 million, or 14–19% of the U.S. population. Rural communities face disadvantages compared to urban areas, including higher poverty, lower educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of five-year cancer incidence and mortality from 2009–2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus non-metropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011–2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in non-metropolitan counties (p<0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in non-metropolitan counties (p<0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011–2016 (3% of 1655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer.
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                Author and article information

                Contributors
                nicole.murray@hci.utah.edu
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                13 March 2024
                March 2024
                : 13
                : 5 ( doiID: 10.1002/cam4.v13.5 )
                : e7058
                Affiliations
                [ 1 ] Huntsman Cancer Institute University of Utah Salt Lake City Utah USA
                [ 2 ] Department of Urology Mayo Clinic Phoenix Arizona USA
                [ 3 ] Department of Urology University of Rochester Rochester New York USA
                [ 4 ] Division of Urology University of Utah Salt Lake City Utah USA
                [ 5 ] Computational Sciences and Engineering Division Oak Ridge National Laboratory Oak Ridge Tennessee USA
                Author notes
                [*] [* ] Correspondence

                Nicole Z. Murray, 1950 Circle of Hope Drive, Salt Lake City, UT 84112, USA.

                Email: nicole.murray@ 123456hci.utah.edu

                Author information
                https://orcid.org/0000-0001-8322-6838
                https://orcid.org/0000-0001-8381-092X
                https://orcid.org/0000-0003-2439-7578
                Article
                CAM47058 CAM4-2023-08-4170.R1
                10.1002/cam4.7058
                10935886
                38477496
                84c8c2da-0d18-47dc-a8ce-6c9a5664c524
                © 2024 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 January 2024
                : 28 August 2023
                : 16 February 2024
                Page count
                Figures: 2, Tables: 2, Pages: 7, Words: 3109
                Funding
                Funded by: National Institutes of Health , doi 10.13039/100000002;
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                March 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:13.03.2024

                Oncology & Radiotherapy
                family,rural health,urogenital neoplasms
                Oncology & Radiotherapy
                family, rural health, urogenital neoplasms

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