Originally published as JCO Early Release 10.1200/JCO.2009.22.0038 on September 14 2009

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Survival Disparities in Patients With Lymphoma According to Place of Residence and Treatment Provider: A Population-Based Study

From the Section of Oncology-Hematology; Summer Undergraduate Research Program, Department of Internal Medicine; Department of Pathology, University of Nebraska Medical Center, Omaha, NE.

Corresponding author: Fausto R. Loberiza Jr, MD, MS, UNMC, Oncology/Hematology Section, 987680 Nebraska Medical Center, Omaha, NE 68198-7680; e-mail: floberiza{at}unmc.edu.

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.

Supported in part by Grants No. USPHS CA36727 from the National Cancer Institute, Department of Health and Human Services, and P30 CA 036727 from the Eppley Cancer Center Support Fund.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Presented at the Annual Meeting of the American Society of Hematology, San Francisco, CA, December 8, 2008.

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