Rural-urban survival disparities for patients with surgically treated lung cancer

Charles D. Logan, Joe Feinglass, Amy L. Halverson, Kalvin Lung, Samuel Kim, Ankit Bharat, David D. Odell*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Nonsmall-cell lung cancer (NSCLC) is a common diagnosis among patients living in rural areas and small towns who face unique challenges accessing care. We examined differences in survival for surgically treated rural and small-town patients compared to those from urban and metropolitan areas. Methods: The National Cancer Database was used to identify surgically treated NSCLC patients from 2004 to 2016. Patients from rural/small-town counties were compared to urban/metro counties. Differences in patient clinical, sociodemographic, hospital, and travel characteristics were described. Survival differences were examined with Kaplan–Meier curves and Cox proportional hazards models. Results: The study included 366 373 surgically treated NSCLC patients with 12.4% (n = 45 304) categorized as rural/small-town. Rural/small-town patients traveled farther for treatment and were from areas characterized by lower income and education(all p < 0.001). Survival probabilities for rural/small-town patients were worse at 1 year (85% vs. 87%), 5 years (48% vs. 54%), and 10 years (26% vs. 31%) (p < 0.001). Travel distance >100 miles (hazard ratio [HR] = 1.11, 95% confidence interval [CI]: 1.07–1.16, vs. <25 miles) and living in a rural/small-town county (HR = 1.04, 95% CI: 1.01–1.07) were associated with increased risk for death. Conclusions: Rural and small-town patients with surgically treated NSCLC had worse survival outcomes compared to urban and metropolitan patients.

Original languageEnglish (US)
Pages (from-to)1341-1349
Number of pages9
JournalJournal of surgical oncology
Issue number7
StatePublished - Dec 2022


  • health disparity
  • nonsmall-cell lung cancer
  • rural health

ASJC Scopus subject areas

  • Oncology
  • Surgery


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