Abstract
Nearly 60 million rural Americans face disparities in cancer surgery access and outcomes within a heterogeneous geographic landscape. This United States population-based study examined regional disparities in access to colorectal cancer (CRC) surgery among rural communities.
Hospitalization data for rural patients undergoing CRC resections were abstracted from the 2007-2020 National Inpatient Sample. Rural patients were identified using the National Center for Health Statistics urban-rural classifications. Four measures were assessed: 1) elective CRC surgery, 2) elective rectal cancer surgery, 3) in-hospital mortality after surgery, and 4) stoma rates. Logistic regression models were estimated to evaluate between-region differences, adjusting for patient- and hospital-level factors.
Among the 331,004 hospitalizations of rural patients who underwent CRC surgery, elective admission rates were highest in the Midwest (76%, omnibus p <.001). Adjusted odds of elective admission were highest in the Midwest and lowest in the South. There were 61,898 rectal cancer surgery hospitalizations identified; of which, hospitalizations in the South had the lowest odds of elective admission (p < 0.001). Hospitalizations of rural patients in the Northeast compared to all other regions experienced 15%-33% greater adjusted odds of in-hospital mortality after CRC surgery. Adjusted stoma rates were higher in the West (10.3%) compared to the Midwest, and the Northeast had (29.7%) higher odds compared to the South.
Geographic disparities in CRC surgery access among rural residents highlight the heterogeneity of rural America, complicating the challenges of adopting a universal approach to address inequities. Exploring underlying factors of these regional differences, such as variations in provider distribution, hospital resources, and local economic conditions is essential to guide clinical innovations and policy interventions.