title: An exploration of urban and rural differences in lung cancer survival among medicare beneficiaries.
abstract: OBJECTIVE
  We tested the relationship between urban or rural residence as defined by rural-urban commuting area codes and risk of mortality in a sample of Medicare beneficiaries with lung cancer.
  
  
  METHODS
  We used Surveillance, Epidemiology, and End Results data linked with Medicare claims to build proportional hazards models. The models tested hypothesized relationships between individual and community characteristics and overall survival for a cohort of Medicare beneficiaries 65 years and older who were diagnosed with lung cancer between 1995 and 1999 (N=26073).
  
  
  RESULTS
  We found no evidence that lung cancer patients in rural areas have poorer survival than those in urban areas. Rather, individual (Medicaid coverage) and regional (lower census tract-level median income) socioeconomic factors and a smaller supply of subspecialists per 10000 individuals 65 years and older were positively associated with a higher risk of mortality.
  
  
  CONCLUSIONS
  Although urban versus rural residence did not directly influence survival, rural residents were more likely to live in poorer areas with a smaller supply of health care providers. Therefore, we still need to be aware of rural beneficiaries' potential disadvantage when it comes to receiving needed care in a timely fashion.
authors.affiliation: RAND Corporation, Santa Monica, CA 90407-2138, USA. lisas@rand.org
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shugarman
authors.forename: Melony E S
authors.initials: ME
authors.lastname: Sorbero
authors.forename: Haijun
authors.initials: H
authors.lastname: Tian
authors.forename: Arvind K
authors.initials: AK
authors.lastname: Jain
authors.forename: J Scott
authors.initials: JS
authors.lastname: Ashwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000534:rehabilitation*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*