Impact of urban–rural residence on treatment and survival in patients with glioblastoma

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Glioblastoma is an aggressive primary brain tumor with a poor prognosis despite multimodal treatment. Geographic residence may influence access to medical care and, consequently, both treatment utilization and survival; however, the impact of urban–rural residence on these outcomes in patients with glioblastoma remains underexplored. Identifying these disparities can help inform targeted strategies to improve outcomes. Patients diagnosed with primary glioblastoma were identified from the Surveillance, Epidemiology, and End Results database. Multivariable logistic regression was used to evaluate the association between residence and the receipt of definitive treatments. Propensity score matching was performed to balance baseline characteristics, and Kaplan–Meier curves were used to estimate cancer-specific survival (CSS). An independent cohort from West China Hospital was additionally included for external validation, with analyses primarily focusing on survival outcomes. A total of 10,041 glioblastoma patients were included. Compared to urban patients, rural patients were less likely to receive local surgery (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.72–0.96, P = .009), radiotherapy (OR = 0.84, 95% CI = 0.72–0.97, P = .012), and chemotherapy (OR = 0.89, 95% CI = 0.80–0.99, P = .046). Post-propensity score matching analysis showed that rural patients had worse CSS compared to urban patients (hazard ratio [HR] = 1.12, 95% CI = 1.05–1.20, P < .001). Subgroup analysis by diagnosis year revealed a narrowing urban–rural disparity over time (2000–2009, HR = 1.15, 95% CI = 1.06–1.25, P < .001; 2010–2019, HR = 1.10, 95% CI = 1.01–1.20, P = .046). Further subgroup analysis indicated that this disparity was consistent regardless of income (median household income < 75,000 United States dollars, HR = 1.11, 95% CI = 1.04–1.19, P = .001; >75,000 United States dollars, HR = 1.08, 95% CI = 1.02–1.20, P = .036). External validation showed a trend toward worse CSS among rural patients, but the difference was not statistically significant (HR = 1.33, 95% CI = 0.96–1.84, P = .085). Overall, rural residence was associated with lower utilization of treatments and worse CSS among patients with glioblastoma. These findings highlight the need for targeted strategies to improve healthcare access and reduce urban–rural disparities in clinical outcomes.