Survival disparities in patients with lymphoma according to place of residence and treatment provider

A population-based study

Fausto R. Loberiza, Anthony J. Cannon, Dennis D. Weisenburger, Julie Marie Vose, Matt J. Moehr, Martin A. Bast, Philip Jay Bierman, Robert G Bociek, James Olen Armitage

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Purpose: Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care. Patients and Methods: Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006. Results: Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB), and 861 (37%) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB. Conclusion: Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.

Original languageEnglish (US)
Pages (from-to)5376-5382
Number of pages7
JournalJournal of Clinical Oncology
Volume27
Issue number32
DOIs
StatePublished - Nov 10 2009

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Lymphoma
Survival
Population
Therapeutics
Cohort Studies
Retrospective Studies
Health

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Survival disparities in patients with lymphoma according to place of residence and treatment provider : A population-based study. / Loberiza, Fausto R.; Cannon, Anthony J.; Weisenburger, Dennis D.; Vose, Julie Marie; Moehr, Matt J.; Bast, Martin A.; Bierman, Philip Jay; Bociek, Robert G; Armitage, James Olen.

In: Journal of Clinical Oncology, Vol. 27, No. 32, 10.11.2009, p. 5376-5382.

Research output: Contribution to journalArticle

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abstract = "Purpose: Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care. Patients and Methods: Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006. Results: Among urban residents, 321 (14{\%}) were treated by university-based providers (UUB) and 816 (35{\%}) were treated by community-based providers (UCB). Among rural residents, 332 (14{\%}) were treated by university-based providers (RUB), and 861 (37{\%}) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95{\%} CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95{\%} CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB. Conclusion: Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.",
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AU - Vose, Julie Marie

AU - Moehr, Matt J.

AU - Bast, Martin A.

AU - Bierman, Philip Jay

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AU - Armitage, James Olen

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N2 - Purpose: Health disparities exist according to an individual's place of residence. We evaluated the association between primary area of residence (urban v rural) according to treatment provider (university based v community based) and overall survival in patients with lymphoma and determined whether there are patient groups that could benefit from better coordination of care. Patients and Methods: Population-based, retrospective cohort study of 2,330 patients with centrally confirmed lymphoma from Nebraska and surrounding states and treated by university-based or community-based oncologists from 1982 to 2006. Results: Among urban residents, 321 (14%) were treated by university-based providers (UUB) and 816 (35%) were treated by community-based providers (UCB). Among rural residents, 332 (14%) were treated by university-based providers (RUB), and 861 (37%) were treated by community-based providers (RCB). The relative risk (RR) of death among UUB, UCB, and RUB were not statistically different. However, RCB had a higher risk of death (RR, 1.37; 95% CI, 1.14 to 1.65; P = .01; and RR, 1.26; 95% CI, 1.06 to 1.49; P = .01) when compared with UUB and RUB, respectively. This association was true in both low- and intermediate-risk patients. Among high-risk patients, UCB, RUB, and RCB were all at higher risk of death when compared with UUB. Conclusion: Survival outcomes of patients with lymphoma may be associated with place of residence and treatment provider. High-risk patients from rural areas may benefit from better coordination of care.

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