Same People, Different Results: Categorizing Cancer Registry Cases Across the Rural-Urban Continuum.

Andrea M Schiefelbein, John K Krebsbach, Amy K Taylor, Amy K Haimson, Patrick R Varley, Melissa C Skala, John M Eason, Noelle K LoConte
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Abstract

Background: Many rural-urban indexes are utilized in cancer research. This variation introduces inconsistencies between studies. Recommendations on index use have prioritized geographical unit over feasibility of inclusion in analysis. We evaluated rural-urban indexes and recommend one for use to increase comparability across studies.

Methods: We assessed 9 US rural-urban indexes regarding their respective rural and urban code ranges; geographical unit, land area, and population distributions; percent agreement; suitability for analysis; and integration feasibility for national, state, and local cancer research. We referenced 1569 Wisconsin Pancreatic Cancer Registry patients to demonstrate how index choice affects patient categorization.

Results: Six indexes categorized rural and urban areas. Indexes agreed on binary rural-urban designation for 88.8% of the US population. As ternary variables, they agreed for 83.4%. For cancer registry patients, this decreased to 73.4% and 60.4% agreement, respectively. Rural-Urban Continuum Codes (RUCC) performed the best in differentiating metropolitan, micropolitan, and rural counties; availability for retrospective and prospective studies; and continuous coding for analysis.

Conclusions: Urban/rural patient categorization changed with index selection. We conclude that RUCC is an appropriate and feasible rural-urban index to include in cancer research, as it is standardly available in national cancer registries, can be matched to patient's county of residence for local research, and it had the least amount of fluctuation of the indices analyzed. Utilizing RUCC as a continuous variable across studies with a rural-urban component will increase reproducibility and comparability of results and eliminate rural-urban index choice as a potential source of discrepancy between studies.

同样的人,不同的结果:癌症登记病例在城乡之间的分类。
背景:癌症研究中使用了许多城乡指数。这种差异造成了研究之间的不一致。有关指数使用的建议将地理单元置于纳入分析的可行性之上。我们对城乡指数进行了评估,并推荐使用一种指数来提高不同研究之间的可比性:我们评估了 9 个美国城乡指数,涉及其各自的农村和城市代码范围;地理单元、土地面积和人口分布;一致性百分比;分析的适宜性;以及整合到国家、州和地方癌症研究中的可行性。我们参考了威斯康星州胰腺癌登记处的 1569 名患者,以展示指数选择对患者分类的影响:结果:六个指数对农村和城市地区进行了分类。88.8%的美国人口的二元城乡分类指标一致。作为三元变量,它们在 83.4% 的人口中达成了一致。对于癌症登记患者,这一比例分别降至 73.4% 和 60.4%。农村-城市连续编码(RUCC)在区分大都市、微型城市和农村地区方面表现最佳;可用于回顾性和前瞻性研究;可连续编码进行分析:结论:城市/农村患者的分类随索引选择而改变。我们得出的结论是,RUCC 是癌症研究中一个合适且可行的城乡指数,因为它在国家癌症登记中是标准可用的,可以与患者的居住县相匹配以进行本地研究,而且它在所分析的指数中波动最小。将 RUCC 作为一个连续变量用于包含农村-城市成分的各项研究,将提高结果的可重复性和可比性,并消除农村-城市指数选择作为研究间差异的潜在来源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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