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• W3022652006 abstract "<h3>Background</h3> To eliminate them, non-small cell lung cancer (NSCLC) care and outcome disparities need to be better understood. <h3>Research Question</h3> How does rurality interact with NSCLC care and outcome disparities? <h3>Study Design and Methods</h3> We examined guideline-concordant use of active treatment for NSCLC across five institutions in one community-based health care system spanning 44% of the Delta Regional Authority catchment area from 2011 to 2017. Institution- and patient-level rurality were based on Rural-Urban Commuting Area codes. Chi-squared, <i>F</i>-tests, and logistic regressions were used to analyze differences across institutions and rurality; survival was examined using log-rank tests and Cox regression. <h3>Results</h3> Of 6,259 patients, 47% resided in rural areas; two of five institutions were rurally located and provided care for 20% of patients. Compared with rural residents at rural institutions, urban and rural residents attending urban institutions were more likely to receive stage-preferred treatment: OR 1.68 (95%CI, 1.44-1.96), and 1.33 (1.11-1.61), respectively, after adjusting for insurance, age, and clinical stage. Urban and rural residents attending urban institutions had a lower hazard of death compared with rural residents attending rural institutions: hazard ratio (HR) 0.69 (0.64-0.75) and 0.61 (0.55-0.67), respectively. Among recipients of stage-preferred treatment, care at urban institutions remained less hazardous: HR 0.7 (0.63-0.79). When further stratified by stage, care for late-stage patients at urban institutions remained less hazardous: HR 0.8 (0.71-0.91). <h3>Interpretation</h3> Rurality-associated treatment and survival disparities were present at the patient and institution levels, but the institution-level disparity was greater. Rural residents receiving care at urban institutions had similar outcomes to urban residents receiving care at urban hospitals. To overcome rurality-associated NSCLC survival disparity, interventions should preferentially target the institution level, including expanding access to higher-quality guideline-concordant care." @default.
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• W3022652006 date "2020-08-01" @default.
• W3022652006 modified "2023-09-24" @default.
• W3022652006 title "Rurality, Stage-Stratified Use of Treatment Modalities, and Survival of Non-small Cell Lung Cancer" @default.
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• W3022652006 doi "https://doi.org/10.1016/j.chest.2020.04.042" @default.
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