Rural and Urban Differences in Cancer Diagnosis Using the 1998 NAMCS

Document Type


Publication Date



It has been well documented that rural populations in this country exhibit significant health discrepancies when compared to their urban counterparts. In addition, rural populations usually have lower income levels, less education, and higher poverty rates. The purpose of this study was to investigate the difference between the proportions of diagnosed cancer associated with rural and urban areas in the United States. Data were obtained using the 1998 National Ambulatory Medical Care Survey (NAMCS). This multi-stage probability survey is a national sample of 1,226 nonfederal physicians. Variables selected for analysis included diagnosis (cancer vs non-cancer), patient's age, race, gender, ethnicity, primary care physician, and metropolitan status (urban vs rural). A total of 571 cancer cases and 22,763 non-cancer cases were analyzed. Data, stratified by age, were tested for homogeneity of cancer risk using the Breslow-Day test (p=0.06). The Mantel-Haenszel procedure was then used to calculate a common odds ratio across these strata. Although results indicated a slight increase in cancer risk among rural populations, analysis of data was not significant [OR=1.034; 95% CI=0.850 to 1.257]. Application of logistic regression supported these findings as well. It was determined that only patient age (p < 0.0001), patient gender (p < 0.0001), and patient primary care physician (p < 0.0001) significantly explained variability in this model. Metropolitan status was not a significant predictor of cancer diagnosis (p=0.4857) after adjusting for these factors.


American Public Health Association Annual Conference (APHA)


Philadelphia, PA