title: Survival of cancer patients in urban and rural areas of Germany--a comparison.
abstract: BACKGROUND
  Cancer care services including cancer prevention activities are predominantly localised in central cities, potentially causing a heterogeneous geographic access to cancer care. The question of an association between residence in either urban or rural areas and cancer survival has been analysed in other parts of the world with inconsistent results. This study aims at a comparison of age-standardised 5-year survival of cancer patients resident in German urban and rural regions using data from 11 population-based cancer registries covering a population of 33 million people.
  
  
  METHODS
  Patients diagnosed with cancers of the most frequent and of some rare sites in 1997-2006 were included in the analyses. Places of residence were assigned to rural and urban areas according to administrative district types of settlement structure. Period analysis and district type specific population life tables were used to calculate overall age-standardised 5-year relative survival estimates for the period 2002-2006. Poisson regression models for excess mortality (relative survival) were used to test for statistical significance.
  
  
  RESULTS
  The 5-year relative survival estimates varied little among district types for most of the common sites with no consistent trend. Significant differences were found for female breast cancer patients and male malignant melanoma patients resident in city core regions with slightly better survival compared to all other district types, particularly for patients aged 65 years and older.
  
  
  CONCLUSIONS
  With regard to residence in urban or rural areas, the results of our study indicate that there are no severe differences concerning quality and accessibility of oncological care in Germany among different district types of settlement.
authors.affiliation: Hamburg Cancer Registry, Authority for Health and Consumer Protection, Hamburg, Germany. Electronic address: Alice.Nennecke@bgv.hamburg.de.
authors.forename: Alice
authors.initials: A
authors.lastname: Nennecke
authors.affiliation: Population Based Cancer Registry Bavaria, Registry Office, Erlangen, Germany.
authors.forename: Karla
authors.initials: K
authors.lastname: Geiss
authors.affiliation: Hamburg Cancer Registry, Authority for Health and Consumer Protection, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hentschel
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Eik
authors.initials: E
authors.lastname: Vettorazzi
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Cancer Registry of Bremen, BIPS - Institute for Epidemiology and Prevention Research, Bremen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Eberle
authors.affiliation: Saarland Cancer Registry, Saarbrücken, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Holleczek
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Adam
authors.initials: A
authors.lastname: Gondos
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality*; D012042:Registries; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Cancer registry; Cancer survival; Germany; Regional variation