Lisa R. Shugarman ^1*, Melony E.S. Sorbero ¹, Haijun Tian ¹, Arvind K. Jain ¹, J. Scott Ashwood ¹

¹ RAND Corporation

^* To whom correspondence should be addressed. E-mail: lisas{at}rand.org.

	Abstract

Objectives. 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 10 000 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.

Key Words: Aging, Cancer, Access to Care, Rural Health, Urban Health