城市和农村肿瘤患者的旅行负担和绕过最近地点进行癌症手术治疗的情况。

IF 3.1 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Tracy Onega, Niveditta Ramkumar, Gabriel A Brooks, Andrew P Loehrer, Nirav S Kapadia, A James O'Malley, Taressa K Fraze, Rebecca E Smith, Qianfei Wang, Sandra L Wong, Anna N A Tosteson
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引用次数: 0

摘要

目的:我们研究了癌症外科治疗的旅行负担与乡村、最近手术设施的地理绕行、癌症类型和死亡率结果之间的关系:利用结肠癌、直肠癌、肺癌或胰腺癌受益人的医疗保险报销和注册数据(2016-2018 年),我们测量了前往最近手术设施的旅行时间和使用的设施。对于那些绕过最近地点的患者,我们研究了旅行时间和乡村地区与手术率的关系。通过多变量回归模型,我们估算了搭桥手术与术后 90 天和一年死亡率之间的关系;并将农村地区作为影响调节因素进行了研究:在 211,025 名癌症受益人中,25.5% 居住在非大都市地区。约66%的大都市/大都市患者和78%的小镇/农村患者绕过了最近的医疗机构。农村地区的增加与绕过最近医疗机构的可能性增加有显著相关性(参照 = 大城市,OR;95%CI:大都市 1.10;1.04-1.16,小城镇/农村 2.08;1.96-2.20。绕过最近的设施与术后 90 天死亡率(OR = 0.79;95%CI 0.74-0.85)和 1 年死亡率(OR = 0.81;95%CI 0.77-0.86)的降低有关。在所有城乡类别中,胰腺癌的 1 年死亡率下降幅度最大(OR;95%CI:大都市 0.63;0.53-0.76;微型城市 0.53;0.29-0.97);小城镇/农村 0.46;0.25-0.86):结论:大多数肺癌、结肠癌、直肠癌或胰腺癌的医疗保险受益人都会绕过最近的癌症外科医疗机构,尤其是农村患者。绕道与术后90天和1年死亡率较低有关。了解绕道的决定因素,尤其是农村患者绕道的决定因素,可以揭示改善癌症治疗效果和减少农村癌症差异的潜在机制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Travel burden and bypassing closest site for surgical cancer treatment for urban and rural oncology patients.

Purpose: We examined the relationship between travel burden for surgical cancer care and rurality, geographic bypass of the nearest surgical facility, cancer type, and mortality outcomes.

Methods: Using Medicare claims and enrollment data (2016-2018) from beneficiaries with cancer of the colon, rectum, lung, or pancreas, we measured travel times to: the nearest surgical facility and facility used. For those who bypassed the nearest, we examined travel time and rurality in relation to surgical rates. Using multivariable regression modeling, we estimated associations of bypass with 90-day postoperative- and one-year mortality; rurality was examined as an effect modifier.

Findings: Among 211,025 beneficiaries with cancer, 25.5% resided in non-metropolitan areas. About 66% of metropolitan/micropolitan, and 78% of small town/rural patients bypassed their closest facility. Increasing rurality was significantly associated with increased likelihood of bypass (Referent = metropolitan, OR; 95%CI: micropolitan 1.10; 1.04-1.16, small town/rural 2.08; 1.96-2.20. Bypassing the nearest facility was associated with decreased likelihood of both 90-day postoperative mortality (OR = 0.79; 95%CI 0.74-0.85) and 1-year mortality (OR = 0.81; 95%CI 0.77-0.86). The greatest decrement in 1-year mortality was for pancreatic cancer across all rural-urban categories (OR; 95%CI: metropolitan 0.63; 0.53-0.76; micropolitan 0.53; 0.29-0.97); small town/rural 0.46; 0.25-0.86).

Conclusions: Most Medicare beneficiaries with lung, colon, rectal, or pancreatic cancer bypassed the closest facility providing surgical cancer care, especially rural patients. Bypassing was associated with a lower likelihood of 90-day postoperative, and 1-year mortality. Understanding determinants of bypassing, particularly among rural patients, may reveal potential mechanisms to improve cancer outcomes and reduce rural cancer disparities.

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来源期刊
Journal of Rural Health
Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生
CiteScore
7.60
自引率
6.10%
发文量
86
审稿时长
>12 weeks
期刊介绍: The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.
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