Rural reversal?

BACKGROUND: Differences in late‐stage cancer risk between urban and rural residents are a key component of cancer disparities. Using data from the Illinois State Cancer Registry from 1998 through 2002, the authors investigated the rural‐urban gradient in late‐stage cancer risk for 4 major types of cancer: breast, colorectal, lung, and prostate. METHODS: Multilevel modeling was used to evaluate the role of population composition and area‐based contextual factors in accounting for rural‐urban variation. Instead of a simple binary rural‐urban classification, a finer grained classification was used that differentiated the densely populated City of Chicago from its suburbs and from smaller metropolitan areas, large towns, and rural settings. RESULTS: For all 4 cancers, the risk was highest in the most highly urbanized area and decreased as rurality increases, following a J‐shaped progression that included a small upturn in risk in the most isolated rural areas. For some cancers, these geographic disparities were associated with differences in population age and race; for others, the disparities remained after controlling for differences in population composition, zip code socioeconomic characteristics, and spatial access to healthcare. CONCLUSIONS: The observed pattern of urban disadvantage emphasized the need for more extensive urban‐based cancer screening and education programs. Cancer 2009. © 2009 American Cancer Society.