Urban and Rural Differences in Access to Care and Treatment for Medicare Beneficiaries with Cancer

Lead researcher:
Lisa S. Shugarman, 310.393.0411 Ext. 7701
Project funded:
September 2004
Project completed:
August 2006

This study builds upon work addressing differences in the quality of cancer care across populations. The literature on the quality of cancer care generally, and the literature exploring differences in the incidence of cancer and outcomes of care provided to cancer patients based on selected socio-demographic characteristics (e.g., gender, age, race, income or socio-economic status) is large; however, little is known about the differences in the diagnosis, treatment and outcomes of care for cancer patients across urban and rural regions of the country.

The overall goals of this project are to:

  • Investigate hypothesized relationships between urban and rural residence and a range of outcomes of care for Medicare beneficiaries with cancer.
  • Explicitly evaluate selected market and provider supply characteristics of selected regions through which geographic variations are hypothesized to affect health outcomes Assess differences in personal (e.g., gender, race) and community (e.g., poverty rate) characteristics in observed patterns of association within and across urban and rural regions.
  • Explore how changes in the supply of providers in urban and rural areas over time may have influenced the outcomes of interest.

Using Surveillance, Epidemiology, and End Results (SEER) data merged with Medicare claims data available from the Centers for Medicare and Medicaid Services (CMS), project staff will examine a series of models testing hypothesized relationships between individual and community characteristics and the outcomes of interest (timing of diagnosis, timing from diagnosis to first treatment, disease-free survival, overall survival). First, urban and rural differences will be estimated in the incidence and prevalence of disease, as well as the treatment, follow-up, and mortality/survival. Second, personal and community characteristics (including provider supply) will be explored in order to explain urban and rural differences in these selected measures. Finally, changes in the supply of providers will be examined to determine the extent these changes have resulted in changes in the outcomes of care over time across urban and rural regions.


There may be products related to this project; please contact the lead researcher for more information.