Patrick Albers MD, Guocheng Huang MD, Safaa Bashir MBBS, Nikhile Mookerji MD, Jacob Bennett BSc, Stacey Broomfield PhD, Anaïs Medina Martín PhD, Sunita Ghosh PhD, Adam Kinnaird MD, PhD
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This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations within a universal health care system, providing insights into the persistent disparities in cancer-specific mortality despite supposed equal access to medical coverage.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort study was conducted using data from the Alberta Cancer Registry (January 1, 1999 to December 31, 2022) and the Alberta Prostate Cancer Research Initiative (APCaRI) (July 1, 2014 to June 7, 2024). There were 45,602,119 person-years from the Alberta Cancer Registry and 8932 men from APCaRI. The exposure was the place of residence, categorized as urban or rural, based on postal codes at the time of diagnosis and death. The primary outcome was prostate cancer-specific mortality.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>Rural men were diagnosed at an older age (66.7 vs. 68.9, <i>p</i><0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, <i>p</i><0.001). Though both groups showed improvements over time, rural areas consistently had higher age-adjusted mortality rates. Despite a 38% relative increase in prostate cancer specific mortality, rural patients had minimal, though statistically significant differences in PSA (9% vs. 11% >20, <i>p</i> = 0.008), stage (40% vs. 46% T2–T4, p<0.001) and Gleason Grade Group (11% vs. 14% ≥4, <i>p</i><0.001) at diagnosis.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The study reveals that rural men experienced significantly worse prostate cancer outcomes compared to urban men. 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引用次数: 0
摘要
目的前列腺癌是一种常见的男性恶性肿瘤，其发病率因地域而异。本研究旨在评估在全民医疗体系下农村和城市人口前列腺癌预后的长期趋势，为在假定医疗覆盖平等的情况下癌症特异性死亡率的持续差异提供见解。方法采用回顾性队列研究，数据来自艾伯塔省癌症登记处（1999年1月1日至2022年12月31日）和艾伯塔省前列腺癌研究倡议（APCaRI）（2014年7月1日至2024年6月7日）。来自艾伯塔省癌症登记处的45,602,119人和来自APCaRI的8932名男性。暴露点是根据诊断和死亡时的邮政编码划分为城市或农村的居住地。主要终点是前列腺癌特异性死亡率。研究发现，农村男性的诊断年龄较大（66.7 vs. 68.9, p < 0.001），并且与城市男性相比，年龄调整后的前列腺癌特异性死亡率更高（52.0 vs. 37.6 / 100000, p < 0.001）。尽管随着时间的推移，两组都有所改善，但农村地区的年龄调整死亡率一直较高。尽管前列腺癌特异性死亡率相对增加38%，但农村患者在诊断时PSA （9% vs. 11% >20, p = 0.008）、分期（40% vs. 46%, T2-T4, p<0.001）和Gleason分级组（11% vs. 14%≥4,p<0.001）差异很小，但有统计学意义。研究表明，农村男性的前列腺癌预后明显比城市男性差。这些发现突出表明，需要采取有针对性的保健干预措施，以改善农村地区获得保健的机会。
The rural disadvantage – prostate cancer outcomes of rural and urban patients over 25 years
Purpose
Prostate cancer is a common malignancy among men, with disparities based on the geographic location. This study aims to evaluate long-term trends in prostate cancer outcomes among rural and urban populations within a universal health care system, providing insights into the persistent disparities in cancer-specific mortality despite supposed equal access to medical coverage.
Methods
A retrospective cohort study was conducted using data from the Alberta Cancer Registry (January 1, 1999 to December 31, 2022) and the Alberta Prostate Cancer Research Initiative (APCaRI) (July 1, 2014 to June 7, 2024). There were 45,602,119 person-years from the Alberta Cancer Registry and 8932 men from APCaRI. The exposure was the place of residence, categorized as urban or rural, based on postal codes at the time of diagnosis and death. The primary outcome was prostate cancer-specific mortality.
Findings
Rural men were diagnosed at an older age (66.7 vs. 68.9, p<0.001) and had higher age-adjusted prostate cancer-specific mortality compared to urban men (52.0 vs. 37.6 deaths per 100,000, p<0.001). Though both groups showed improvements over time, rural areas consistently had higher age-adjusted mortality rates. Despite a 38% relative increase in prostate cancer specific mortality, rural patients had minimal, though statistically significant differences in PSA (9% vs. 11% >20, p = 0.008), stage (40% vs. 46% T2–T4, p<0.001) and Gleason Grade Group (11% vs. 14% ≥4, p<0.001) at diagnosis.
Conclusions
The study reveals that rural men experienced significantly worse prostate cancer outcomes compared to urban men. These findings highlight the need for targeted health care interventions to improve access to care in rural areas.
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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