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Urban–rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer
  1. Audrey Alforque Thomas1,
  2. Alison Pearce2,
  3. Ciaran O'Neill3,
  4. Michal Molcho4,
  5. Linda Sharp5
  1. 1Health Promotion Research Centre, National University of Ireland, Galway, Ireland
  2. 2National Cancer Registry, Cork, Ireland
  3. 3School of Business and Economics, National University of Ireland, Galway, Ireland
  4. 4School of Health Sciences, National University of Ireland, Galway, Ireland
  5. 5Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Audrey Alforque Thomas, Office of Planning and Analysis, University of California, Berkeley, University Hall, Berkeley, CA 94702, USA; audrey{at}


Background Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancer-directed surgery is an influential and significant prognostic factor. In a population-based study, we determined how urban/rural residence was related to surgery receipt for patients with non-small cell lung cancer. We assessed the relationship between relative survival and patients' area of residence, taking into account surgery receipt and area socioeconomic level.

Methods We extracted data from the National Cancer Registry Ireland on patients with non-small cell lung cancer diagnosed during 1994–2011 and linked to area-level data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancer-directed surgery using logistic regression with postestimation of adjusted proportions. Relative survival estimates with follow-up to 31 December 2012 were calculated for all cases and stratified by surgery receipt, adjusting for clinical variables, area socioeconomic level and other sociodemographic characteristics.

Results 15 031 people diagnosed with non-small cell lung cancer were included in the analysis. On the basis of the multiple logistic regression model, a significantly larger proportion of urban patients (adjusted proportion 23%) as compared with rural patients (adjusted proportion 21%) received surgery (p<0.001). In multivariate analysis, rural residence was significantly related to a decrease in excess mortality for all cases (HR 0.90, 95% CI 0.87 to 0.94, p<0.001) and for non-surgical cases (HR 0.88, 95% CI 0.85 to 0.92, p<0.001).

Conclusions The findings point to the need for targeted policies addressing access to treatment for rural patients with non-small cell lung cancer.

  • Cancer epidemiology
  • Health inequalities

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  • Contributors All authors contributed to the study concepts, data analysis and interpretation, manuscript editing and manuscript review. AAT and LS contributed to data acquisition and quality control of data. In addition to AAT and LS, MM contributed to the study design. AAT conducted the statistical analysis and prepared the manuscript.

  • Funding This study was supported by a Health Research Board, Ireland, Interdisciplinary Capacity Enhancement Award (ICE/2012/09).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.