Demographics and access to head and neck cancer care in rural areas compared to urban areas in Germany

Abstract

BackgroundDemographic development in rural and urban areas differs substantially. Demographics and access to specialized head and neck cancer centers may affect head and neck cancer patients' (HNCP) outcomes. Here, we compare epidemiological indicators and outcomes of HNCP in rural and urban Germany.Patients and MethodsIn a retrospective analysis of data from the Center for Cancer Registry Data (ZfKD) between 2002 and 2017, 212,920 HNCP were included. Incidence, demographics, travel distance to specialized centers, and ground values were compared between rural and urban areas with a focus on their association with patient outcomes.ResultsThe mean age of HNCP was significantly higher in urban areas (mean difference = 1.4 years; p < 0.0001), but increased at a comparable rate (p = 0.26) in rural and urban areas during the observation period. Gender imbalance was higher in rural areas (mean ratio of men/women: 4.1 vs. 3.1; p < 0.0001), but showed a comparable trend toward equilibration in both, rural and urban districts (p = 0.46). The portion of HNCP of the entire HNCP population living in urban areas increased from 55.9% in the year 2002 to 76.4% in the year 2017. There was no significant difference or change in the ratio of advanced to low UICC stage during the observation period (p = 0.26). However, travel distances to medical centers were higher in rural areas, especially (p < 0.0001) in East Germany. Median survival of HNCP in rural areas was significantly lower than in urban areas (42 months [SEM = 0.7; CI: 40.5–43.5] vs. 54 months [SEM = 1.2; CI: 51.7–56.3]; p < 0.0001) in East Germany, whereas in West Germany no significant difference was observed (59 months [SEM = 0.8; CI: 57.4–60.6] vs. 60 months [SEM = 0.5; CI: 59.0–61.0]; p = 0.15).ConclusionsPlace of residence contributes to survival outcome of HNCP. Access to specialized care and socioeconomic factors could be improved in East Germany.

Regional outcome disparities in German head and neck cancer patients: Shorter survival in Eastern Germany

“…49 In addition, a subsequent extension of this study to urban and rural regions in Germany could provide further insights. 50 Finally, this study shows the need to enhance cancer data availability and accuracy of documentation. Despite of the mandatory reporting of cancer-related data to cancer registries in Germany since 2009, collected data still have a high prevalence of missing data.…”

“…In this manner, the consolidation of a welfare state, facilized health care access, and an enhanced political inclusion of citizens are thought to be helpful 49 . In addition, a subsequent extension of this study to urban and rural regions in Germany could provide further insights 50 …”

“… 49 In addition, a subsequent extension of this study to urban and rural regions in Germany could provide further insights. 50 …”