XXXX in Kentucky: the impact of age, smoking status, and rural residence.

@entity1 @entity1204 @entity4736 @entity5 @entity16071
INTRODUCTION: The study objectives were to assess the effect of age, to evaluate the impact of smoking, and to determine the effect of rural residence on @entity5 characteristics, treatment modalities, and outcomes for Kentucky's @entity1204 @entity1 . METHODS: The Kentucky Cancer Registry identified Kentucky residents diagnosed with @entity1204 from 1995 to 2002. Data abstracted included demographics, @entity5 characteristics, treatment, and recurrence/survival status. RESULTS: Three thousand five hundred and sixty-two @entity1 were diagnosed with @entity1204 . Mean age at diagnosis decreased significantly (P=0.0388) over the 7-year period. Smokers had higher grade, stage, and worse outcomes. Rural @entity1 more often lacked commercial insurance, underwent less comprehensive surgical evaluation, and had less multimodality treatment. Increasing age (P<0.0001), positive or unknown smoking status (P=0.0003), black race (P<0.0001), no commercial insurance (P<0.0001), increasing grade or advanced stage (P<0.0001), small size of treating hospital (P<0.0001), and unknown nodal status (P<0.0001) were negatively associated with disease-specific survival. Lymph node sampling was performed in only 38.6% of @entity1 . On multivariate analysis, age ( @entity4736 .38 for 10 year increments; P<0.0001), smoking ( @entity4736 .38; P=0.008), no commercial insurance or Medicaid ( @entity4736 .87; P=0.0007), rural residence (RR 0.77; P=0.011), advanced stage and grade (RR 7.96, 3.96; P<0.0001), and no nodal evaluation or unknown nodal status ( @entity16071 .32, 2.51; P<0.0001) significantly effected disease-specific survival. CONCLUSIONS: Our data support a trend toward a younger age for @entity1204 diagnosis, confirm the adverse impact of smoking and socioeconomic factors, and demonstrate an association between incomplete surgical staging and decreased survival.
