Abstract
It is unknown whether urban versus rural residency affects pancreatic cancer survival in a universal tax-financed healthcare system. We conducted a nationwide, population-based cohort study of all patients diagnosed with pancreatic cancer in Denmark from 2004–2015. We used nationwide registries to collect information on characteristics, comorbidity, cancer-directed treatment, and vital status. We followed the patients from pancreatic cancer diagnosis until death, emigration, or 1 October 2017, whichever occurred first. We truncated at five years of follow up. We stratified patients into calendar periods according to year of diagnosis (2004–2007, 2008–2011, and 2012–2015). We used Cox proportional hazards model to compute hazard ratios (HRs) with associated 95% confidence intervals (CIs) of death, comparing patients in urban and rural areas. HRs were adjusted for age, sex, comorbidity, tumor stage, and localization. In a sub-analysis, we also adjusted for cancer-directed treatment. We included 10,594 patients diagnosed with pancreatic cancer. Median age was 71 years (inter-quartile range: 63–78 years), and half were men. The majority (61.7%) lived in an urban area at the time of diagnosis. When adjusting for potential confounders, we observed a better survival rate among pancreatic cancer patients residing in urban areas compared with rural areas (adjusted HR: 0.92; 95% CI: 0.87–0.98). When taking treatment into account, the association was unclear (adjusted HR: 0.96; 95% CI: 0.88–1.04). Pancreatic cancer patients residing in urban areas had a slightly better survival rate compared with patients in rural areas.
Highlights
Pancreatic cancer accounts for 330,000 deaths globally each year, posing a major healthcare challenge [1, 2]
hazard ratios (HRs) were adjusted for age, sex, Charlson Comorbidity Index (CCI) score, year of pancreatic cancer diagnosis, tumor location, and American Joint Committee on Cancer (AJCC) stage
There was no difference in age, sex, CCI score, calendar period of diagnosis, tumor location, or AJCC stage between patients in urban and rural areas
Summary
Pancreatic cancer accounts for 330,000 deaths globally each year, posing a major healthcare challenge [1, 2]. Area of residency affects pancreatic cancer survival patients are not completely anonymized and data can not be shared. The data are extracted from the Danish healthcare registries by the Danish Health Data Authority. These data are available to researchers upon application. These data can only be obtained with permission from the Danish Data Protection Agency (www.datatilsynet.dk), who gave the permission to conduct this study. No ethical board approval is needed in Denmark for this kind of studies and no consent from patient is needed to use this kind of data
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