Colorectal Cancer Characteristics and Mortality From Propensity Score-Matched Cohorts of Urban and Rural Veterans

Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths in the United States. Rural living poses special challenges to CRC screening and management, but it is unclear whether rural/urban disparities persist within the Veterans Health Administration (VHA).

This study used VHA data to examine characteristics and mortality among veterans with newly diagnosed CRC. Urban areas were defined using Rural Urban Commuting Area categories 1.0 and 1.1; all other areas were classified as rural. Propensity score-matching analysis was used to address differences in baseline characteristics and compare mortality between rural and urban veterans with CRC. An additional propensity score-matching analysis focused on CRC among veterans aged ≤ 45 years.

Of 2,460,727 individuals, there were 19,422 urban and 10,797 rural veterans with CRC (fiscal years 2016-2021). In rural areas, 83.6% of patients with CRC were White, compared to 67.8% in urban areas. Veterans with CRC in rural areas were also older, more likely to be obese, but had a lower Charlson Comorbidity Index (all P < .05). In the propensity score-matched cohort, baseline demographics and comorbidities were similar between rural and urban CRC patients. Total mortality occurred in 3702 urban veterans (34.3%) and 3763 rural veterans (34.9%) (hazard ratio [HR], 1.01; 95% CI, 0.97-1.06, P = .53). More patients with CRC were aged ≤ 45 years in urban areas (n = 391, 2.0%) than in rural areas (n = 160, 1.5%; P = .001), and their mortality was similar in the propensity score-matched group (HR, 0.97; 95% CI, 0.57-1.63).

Veterans with CRC in rural or urban areas had similar survival outcomes. The study implies that an integrated health system may help alleviate disparities between rural and urban America.