Stage at Diagnosis for Common Cancers According to Rurality, Area Deprivation and Insurance, 2017-2021.

Abstract

Poor access to care among rural and vulnerable populations may result in later stage cancer diagnoses. Using Maine Cancer Registry data (2017-2021) we examined relationships between rurality, insurance, area deprivation index (ADI), and stage for breast, colorectal, lung/bronchus, and prostate cancers. Among 21,208 cancers, regional/distant spread at diagnosis was present among 24% of breast, 60% colorectal, 69% lung/bronchus, and 25% of prostate. In multivariable model we modeled odds of being diagnosed with regional/distant (vs in situ/local spread) according to insurance, rurality, and ADI. Compared to commercial insurance, we observed higher odds of diagnosis at regional/distant stage (vs in situ/localized) associated with having Medicaid insurance for breast (AOR 1.65, 95% CI 1.33-2.04), colorectal (AOR 1.46, 95% CI 1.09-1.98), and prostate (AOR 1.88, 95% CI 1.30-2.70) cancers but no association for lung cancer. People living in isolated rural areas had higher odds of being diagnosed with later stage colorectal(AOR 1.24, 95% CI 1.01-1.53), lung/bronchus (AOR 1.22, 95% CI 1.04-1.43) and prostate cancers (AOR 1.24, 95% CI 1.04-1.47) compared to urban dwellers. Living in isolated rural areas or being insured by Medicaid was associated with later stage cancer diagnoses compared with those in more urban areas and with commercial insurance. This suggests an opportunity to improve early detection among these vulnerable populations.