title: Kidney Cancer in Rural Illinois: Lower Incidence Yet Higher Mortality Rates.
abstract: To determine if rural status was associated with kidney and renal pelvis cancer (KCa) incidence and mortality in Illinois while controlling for known KCa risk factors and access to care variables.
  
  
  
  Age-adjusted KCa incidence rates from 1991 to 2010 were calculated from Illinois State Cancer Registry data. Age-adjusted KCa mortality rates were obtained from health statistics embedded within SEER*Stat. Rural Urban Continuum Codes designated Illinois' 102 counties as urban, rural adjacent to, and rural non-adjacent to a metropolitan area. County-level demographics and physician density were obtained from the Area Health Resource File. Behavioral Risk Factor Surveillance System data were used for smoking, obesity, and hypertension prevalence. Analysis of variance, correlation, and regression analyses were used.
  
  
  
  The incidence of KCa was found to be higher among urban compared to rural counties after controlling for known risk factors (P < .01). A larger proportion of cases were diagnosed at a localized stage in urban counties (<0.01). Mortality rates were significantly higher in rural counties (P = .02). The final regression model found rural status, higher incidence rate, fewer with localized stage at diagnosis, and lower urologist density to be variables significantly associated with higher KCa mortality.
  
  
  
  KCa incidence was higher in urban counties whereas mortality was higher in rural counties. The higher number of KCa cases diagnosed at a localized stage in urban counties and lower urologist density in rural counties suggest that poorer access to care may contribute to higher KCa mortality in rural Illinois. Telemedicine may be an opportunity to improve this disparity.
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL. Electronic address: dsadowski@siumed.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sadowski
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Geiger
authors.affiliation: Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Georgia S
authors.initials: GS
authors.lastname: Mueller
authors.affiliation: Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Whitney E
authors.initials: WE
authors.lastname: Zahnd
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Shaheen R
authors.initials: SR
authors.lastname: Alanee
authors.affiliation: Division of Urology, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000401:mortality; D007682:Kidney Pelvis; D012307:Risk Factors; D012423:Rural Health; D013997:Time Factors