Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State
Menée dans l'Etat du Maine à partir de données portant sur 1 223 006 participants, cette étude analyse l'association entre la ruralité, un indicateur de défavorisation de la zone géographique, la prévalence du cancer du poumon et la mortalité
We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality.We conducted a population-based cross-sectional analysis of: prevalent lung cancers from a statewide all-payer claims dataset 2012-2016, lung cancer deaths in Maine from the state death registry 2012-2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small/isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by Behavioral Risk Factor Surveillance System.Among 1,223,006 adults aged 20+ during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates, (prevalence rate ratio for ADI quintile 5 compared to quintile 1, 1.41 (95% CI 1.30-1.54)) and (mortality rate ratio, 1.59 (95% CI 1.41-1.79).Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions, and to improve patient access to lung cancer prevention, screening, and treatment services.
JNCI Cancer Spectrum 2020