Trends in stage, treatment initiation, and survival disparity among individuals diagnosed with non-small cell lung cancer by rural-urban residency in the US.
Abstract
171 Background: Rural–urban disparities in lung cancer care and outcomes have been well documented in the US. However, less is known about how these disparities have changed over time with the evolution of novel therapy. We aimed to examine trends in rural–urban disparities in stage at diagnosis, timely treatment initiation, and survival among people with non-small cell lung cancer (NSCLC). Methods: We identified 1,188,656 individuals newly diagnosed at age ≥18 years with stages I-IV NSCLC 2010 - 2023 from the National Cancer Database. Study outcomes included stage at diagnosis, timely treatment initiation ≤30 days of diagnosis, and 2- year overall survival. Multivariable logistic regression and Cox proportional hazards models were used to compare outcomes over time by rural-urban residency overall and by race, adjusting for sociodemographic characteristics. Results: Compared to individuals residing in large metropolitan areas, people with NSCLC in small metropolitan and nonmetropolitan areas were less likely to have timely treatment initiation or have superior survival over the study period. These differences increased over time (Table). For example, compared with people residing in large metropolitan areas, people residing in nonmetropolitan areas experienced a 4% higher hazard of mortality during 2010-2016 (hazard ratio [HR]=1.04; 95% CI, 1.03–1.05), and this number increased to 6% during 2017–2023 (HR=1.06; 95% CI, 1.05–1.07). The widening rural–urban disparities in survival were more pronounced among non-Hispanic Black individuals than non-Hispanic White individuals, leading to the greatest current Black-White disparities in nonmetropolitan residents with NSCLC. Conclusions: Rural–urban differences in care and outcomes of NSCLC have widened over time, underscoring the need for targeted interventions to improve access and timeliness of care in rural communities. Trends in outcomes by rural-urban residency among people with NSCLC. Outcomes Rural-urban groups 2010-2016 2017-2023 Early-stage diagnosis (I-II) (odds ratio) Large metropolitan Reference Small metropolitan 0.97 (0.96-0.99) 1.01 (1.00-1.03) Nonmetropolitan 0.97 (0.96-0.99) 0.99 (0.98-1.01) Initiating treatment ≤30 days (odds ratio) Large metropolitan Reference Small metropolitan 0.96 (0.95-0.97) 0.87 (0.86-0.88) Nonmetropolitan 1.00 (0.99-1.02) 0.88 (0.86-0.89) 2-year survival (hazard ratio) Large metropolitan Reference Small metropolitan 1.05 (1.04-1.06) 1.06 (1.05-1.06) Nonmetropolitan 1.04 (1.03-1.05) 1.06 (1.05-1.07)