Does rurality predict poorer cancer survival? – An international meta-analysis and narrative synthesis of evidence for potential mechanisms

Problem

Studies from around the world separately appear to demonstrate that rural patients have poorer health outcomes than urban counterparts. Several studies appear to suggest that cancer outcomes are poorer in rural populations, but why has never been satisfactorily explained. Rurality, however, can be differently defined in different contexts and can be confounded by, for example, poorer socioeconomic status.

Approach

We aimed to to conduct a meta-analysis exploring the relationship between rural residence and cancer survival, and a systematic narrative review of evidence for potential underpinning mechanisms of any differences noted.

[1] A systematic review was conducted following established techniques. Included studies reported on differential cancer survival between rural and urban populations making adjustments for socioeconomic status. [2] A meta-analysis was conducted to produce an overall hazard ratio for cancer survival in rural versus urban-dwellers. [3] A narrative commentary was written synthesising the potential mechanisms which investigators had hypothesized to underpin a rural-urban cancer survival difference.

Findings

Overall rural-dwellers were significantly more likely to die when they developed cancer (Hazard Ratio 1.06 (95% CI’s 1.01 – 1.12)) than urban-dwellers. Little good evidence existed for why this difference existed but potential mechanisms offered by researchers could be grouped under the following themes: Patient Level Characteristics; Institutions; Community, Culture and Environment; Policy and Service Organization.

Consequences

Living in a rural area appears to worsen cancer survival. This has effect has been observed in regions where rurality means different things. Several potential mechanisms have been suggested for the effect, but very little good evidence supports their true impact. More research is required to understand why rural populations do worse when they develop cancer.