title: Urban-rural differences in cancer-directed surgery and survival of patients with non-small cell lung cancer.
abstract: Lung cancer is the leading cause of cancer death worldwide. Clinically appropriate cancer-directed surgery is an influential and significant prognostic factor. In a population-based study, we determined how urban/rural residence was related to surgery receipt for patients with non-small cell lung cancer. We assessed the relationship between relative survival and patients' area of residence, taking into account surgery receipt and area socioeconomic level.
  
  
  
  We extracted data from the National Cancer Registry Ireland on patients with non-small cell lung cancer diagnosed during 1994-2011 and linked to area-level data on socioeconomic indicators and urban/rural categories. We calculated ORs for receipt of cancer-directed surgery using logistic regression with postestimation of adjusted proportions. Relative survival estimates with follow-up to 31 December 2012 were calculated for all cases and stratified by surgery receipt, adjusting for clinical variables, area socioeconomic level and other sociodemographic characteristics.
  
  
  
  15 031 people diagnosed with non-small cell lung cancer were included in the analysis. On the basis of the multiple logistic regression model, a significantly larger proportion of urban patients (adjusted proportion 23%) as compared with rural patients (adjusted proportion 21%) received surgery (p<0.001). In multivariate analysis, rural residence was significantly related to a decrease in excess mortality for all cases (HR 0.90, 95% CI 0.87 to 0.94, p<0.001) and for non-surgical cases (HR 0.88, 95% CI 0.85 to 0.92, p<0.001).
  
  
  
  The findings point to the need for targeted policies addressing access to treatment for rural patients with non-small cell lung cancer.
authors.affiliation: Health Promotion Research Centre, National University of Ireland, Galway, Ireland.
authors.forename: Audrey Alforque
authors.identifier: 0000-0001-5762-6184
authors.initials: AA
authors.lastname: Thomas
authors.affiliation: National Cancer Registry, Cork, Ireland.
authors.forename: Alison
authors.initials: A
authors.lastname: Pearce
authors.affiliation: School of Business and Economics, National University of Ireland, Galway, Ireland.
authors.forename: Ciaran
authors.initials: C
authors.lastname: O'Neill
authors.affiliation: School of Health Sciences, National University of Ireland, Galway, Ireland.
authors.forename: Michal
authors.initials: M
authors.lastname: Molcho
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000328:Adult; D000073116:Cancer Survivors / Q000706:statistics & numerical data*; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007494:Ireland; D008175:Lung Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012111:Residence Characteristics; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: CANCER; Cancer epidemiology; Health inequalities; MARITAL STATUS; SOCIO-ECONOMIC