Urban and rural differences in outcomes of head and neck cancer.

OBJECTIVES/HYPOTHESIS: To assess for potential urban and rural disparities in head and neck cancer (HNC) outcomes within a single-payer healthcare system. STUDY DESIGN: A large retrospective population-based cohort analysis of consecutive HNC patients treated in British Columbia, Canada between 2001 and 2010 was conducted. METHODS: All patients diagnosed with HNC from 2001 to 2010 and referred to any one of five British Columbia Cancer Agency centers for management were reviewed. Based on census data, patients were classified into: 1) rural, 2) small urban, 3) moderate urban, and 4) large urban areas. Kaplan-Meier methods and Cox regression models were used to correlate site of residence with overall survival (OS), controlling for prognostic factors that included sociodemographic and other tumor and treatment-related characteristics. RESULTS: We identified 3,036 patients; the median age was 64 years, 26% were women, and 32% had Eastern Cooperative Oncology Group (ECOG) 0 or 1. The majority resided in large urban areas (55%) followed by rural (22%), moderate urban (13%), and small urban (10%). In regression analyses, smoking (hazard ratio [HR]: 2.10, 95% confidence interval [CI]: 1.28-3.45, P < .001), ECOG 2 + (HR: 3.44, 95% CI: 2.26-5.22, P < .001), oral cavity (HR: 1.54, 95% CI: 1.03-2.32, P = .04) and hypopharyngeal tumors (HR: 2.31, 95% CI: 1.42-3.77, P = .00), and large tumor size (HR: 1.69, 95% CI: 1.08-2.64, P = .02) were correlated with inferior OS, but site of residence was not. When stratified by type of treatment, OS remained similar irrespective of urban or rural residence. CONCLUSIONS: Urban-rural differences in HNC survival outcomes were not observed. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:852-858, 2018.

Correlation between County-Level Surgeon Density and Mortality from Colorectal Cancer.

PURPOSE: We aimed to explore the effect of county-level general surgeon (GS) and colorectal surgeon (CS) density on colorectal cancer (CRC) mortality and to identify additional county characteristics associated with outcomes. METHODS: Using data from the Area Resource File, US Census, and National Cancer Institute, we developed multivariate regression models to determine the effect of density of GS and CS on CRC death between 2005 and 2009 while controlling for CRC incidence, county demographics, and other socioeconomic factors. RESULTS: In total, we included 1767 counties: Mean CRC incidence and death rates were 64.9 and 19.9 %, respectively. In this cohort, 45 % were metropolitan areas. Mean GS and CS densities were 7.2 and 0.15 per 100,000 people, respectively. Counties with at least 1 GS had a statistically significant decrease in CRC-specific mortality (beta coefficient -0.18, p < 0.001). Increasing GS density beyond 8 per 100,000 people did not result in any further meaningful reductions in mortality. The presence of at least 1 CS at the county-level was not associated with differences in CRC mortality (beta coefficient -0.021, p = 0.37). Metropolitan counties and a larger percentage of individuals who were <65 years old were associated with decreased CRC mortality. Conversely, a higher proportion below the poverty line was correlated with a significant increase in CRC mortality. CONCLUSION: Unlike CS, the presence of GS at the county-level was associated with lower CRC mortality. However, increasing GS density beyond a certain point did not result in further meaningful reductions in mortality. A balanced strategy of distributing the surgical workforce across all counties can result in population-based improvements in CRC outcomes.

Community-based newborn hearing screening programme for early detection of permanent hearing loss in Iran: an eight-year cross-sectional study from 2005 to 2012.

OBJECTIVES: We here present the results of the first eight years of the newborn hearing screening programme in Iran, with a view to establishing the prevalence of hearing impairment among infants, and the efficacy of the programme. METHODS: A total of 3,350,995 infants were screened using the series method of transient evoked otoacoustic emissions (TEOAEs)/automated auditory brainstem responses (AABRs), between 2005 and 2012. The infants were first tested for TEOAEs (three times). Based on the results of this test, the positive cases were referred to the next stage, where they were tested for AABRs. If they also tested positive on AABRs, they were referred to the diagnostic and rehabilitation stages. RESULTS: Results of this study indicated an infant hearing impairment prevalence of 3 per 1000. Although this rate was as high as 5 per 1000 in the early years of the programme, it decreased to 2.6 per 1000 in the last year. The absolute referral rate was 14.5% in the first stage, which decreased to 0.9% and 0.2% in the second and the third stages, respectively. The follow-up rate was 70% in the first stage, which increased up to 73% and 85% in the second and the third stages, respectively. CONCLUSION: The study results suggest that the prevalence of hearing impairment in infants in Iran is comparable with that in developed and developing countries, and that the series TEOAEs/AABRs method used in the screening programme in Iran is efficient.