Rural-urban disparities in mortality from gastrointestinal (GI) cancer.

Abstract

644 Background: There are notable economic, social, and political challenges to rural healthcare delivery in the US. Patients with GI cancer have high symptom burden and complex needs, challenging healthcare infrastructure. We investigated U.S. rural-urban disparities in age-adjusted mortality rates (AAMRs) from GI cancers. Methods: We utilized the CDC Wonder database to analyze deaths from GI cancer from 1999 to 2019. Per the 2013 US Census classification, we created population categories using the NCHS Urban-Rural Classification Scheme: large metropolitan (population, ≥1 million), small-or-medium-sized metropolitan (50,000-999 999), and rural (<50,000) areas. We calculated AAMRs and stratified results by age, sex, and race/ethnicity. We estimated annual percentage change (APC) in AAMR using a linear regression model of the log-scale with interactions between subgroup and year to examine differential changes over time. Results: We identified 3,020,133 deaths from GI cancers. The overall APC in AAMR was -0.9%, 95%CI, -0.8 to -1.0%. Rural areas noted least improvement in AAMR (APC, -0.6%; 95% CI, -0.4 to -0.6%, interaction p < 0.001) compared to large (APC, -1.2%; 95% CI, -1.1 to -1.3%) and small-or-medium-sized (APC, -0.8%; 95% CI - 0.7 to -0.9%) metropolitans. AAMR in rural areas decreased from 49.2/100,000 in 1999 to 43.8/100,000 in 2019 (p < 0.001; 2019 rural AAMR was highest across all areas) (Table). Across all areas, men had greater AAMRs (p<0.001) and lower reduction in APC (interaction p < 0.001) than women. Non-Hispanic Black individuals (NHBs) had highest AAMRs among all racial/ethnic groups and across all areas (p<0.001). Among those with age≥65 years, NHBs had the highest AAMRs; 367.3/100,000 in 1999 and 266.7/100,000 in 2019, and NHBs living in rural areas had the lowest APC. All racial/ethnic groups saw reductions in AAMRs across all areas. Conclusions: In this national analysis over 2 decades, rural residents with GI cancer experienced greater mortality, and the least improvement in mortality over time. Our findings support ongoing congressional policy to urgently develop infrastructure and improve cancer care access in rural areas. [Table: see text]