Risks of adverse health outcomes among older rural prostate cancer survivors in the SEER-Medicare data

Abstract

Background

Rural prostate cancer patients face challenges such as greater distance for cancer treatment and care fragmentation. There have been very few studies investigating adverse health outcomes among prostate cancer survivors residing in rural areas. A comprehensive evaluation of adverse health outcomes among rural prostate cancer patients is needed to understand potential health disparities and provide scientific evidence for interventions. The aims of this study were to investigate prevalent and incident adverse health outcomes among older rural prostate cancer survivors compared to urban prostate cancer survivors in the United States.

Methods

The SEER-Medicare linked database was used to identify first primary prostate cancer survivors. Fine-Gray subdistribution hazard models were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI), comparing rural prostate cancer patients to urban prostate cancer patients.

Results

A total of 37,126 rural prostate cancer survivors and 109,176 urban prostate cancer survivors were identified. We observed that rural prostate cancer survivors had a higher prevalence of rheumatoid arthritis/osteoarthritis (22.1% vs 20.9%; P-value <.001) and chronic obstructive pulmonary disease (COPD)/bronchiectasis (14.2% vs 10.5%; P-value <.001). A higher incident risk of acute myocardial infarction, COPD/bronchiectasis, hip pelvic fracture, and rheumatoid arthritis/osteoarthritis among rural prostate cancer was observed compared to their urban counterparts >5 years after cancer diagnosis.

Conclusions

This study provides important results on the prevalence and incident adverse health outcomes among older rural prostate cancer survivors. Further investigation into how other factors influence these disparities is warranted.