Urban versus rural residency and pancreatic cancer survival: A Danish nationwide population-based cohort study

Jakob Kirkegård, Morten Ladekarl, Claus Wilki Fristrup, Carsten Palnæs Hansen, Mogens Sall, Frank Viborg Mortensen

    Abstract

    It is unknown whether urban versus rural residency affects pancreatic cancer survival in a universal tax-financed healthcare system. We conducted a nationwide, population-based cohort study of all patients diagnosed with pancreatic cancer in Denmark from 2004-2015. We used nationwide registries to collect information on characteristics, comorbidity, cancer-directed treatment, and vital status. We followed the patients from pancreatic cancer diagnosis until death, emigration, or 1 October 2017, whichever occurred first. We truncated at five years of follow up. We stratified patients into calendar periods according to year of diagnosis (2004-2007, 2008-2011, and 2012-2015). We used Cox proportional hazards model to compute hazard ratios (HRs) with associated 95% confidence intervals (CIs) of death, comparing patients in urban and rural areas. HRs were adjusted for age, sex, comorbidity, tumor stage, and localization. In a sub-analysis, we also adjusted for cancer-directed treatment. We included 10,594 patients diagnosed with pancreatic cancer. Median age was 71 years (inter-quartile range: 63-78 years), and half were men. The majority (61.7%) lived in an urban area at the time of diagnosis. When adjusting for potential confounders, we observed a better survival rate among pancreatic cancer patients residing in urban areas compared with rural areas (adjusted HR: 0.92; 95% CI: 0.87-0.98). When taking treatment into account, the association was unclear (adjusted HR: 0.96; 95% CI: 0.88-1.04). Pancreatic cancer patients residing in urban areas had a slightly better survival rate compared with patients in rural areas.

    Original languageEnglish
    JournalPLoS One
    Volume13
    Issue number8
    Pages (from-to)e0202486
    ISSN1932-6203
    DOIs
    Publication statusPublished - 2018

    Keywords

    • Age Factors
    • Aged
    • Cohort Studies
    • Comorbidity
    • Denmark/epidemiology
    • Female
    • Follow-Up Studies
    • Humans
    • Male
    • Middle Aged
    • Pancreatic Neoplasms/epidemiology
    • Proportional Hazards Models
    • Rural Health
    • Rural Population
    • Sex Factors
    • Survival Rate
    • Urban Health
    • Urban Population

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