Rural reversal? Rural-urban disparities in late-stage cancer risk in Illinois

Sara McLafferty, Fahui Wang

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Differences in late-stage cancer risk between urban and rural residents are a key component of cancer disparities. Using data from the Illinois State Cancer Registry from 1998 through 2002, the authors investigated the rural-urban gradient in late-stage cancer risk for 4 major types of cancer: breast, colorectal, lung, and prostate. METHODS: Multilevel modeling was used to evaluate the role of population composition and area-based contextual factors in accounting for rural-urban variation. Instead of a simple binary rural-urban classification, a finer grained classification was used that differentiated the densely populated City of Chicago from its suburbs and from smaller metropolitan areas, large towns, and rural settings. RESULTS: For all 4 cancers, the risk was highest in the most highly urbanized area and decreased as rurality increases, following a J-shaped progression that included a small upturn in risk in the most isolated rural areas. For some cancers, these geographic disparities were associated with differences in population age and race; for others, the disparities remained after controlling for differences in population composition, zip code socioeconomic characteristics, and spatial access to healthcare. CONCLUSIONS: The observed pattern of urban disadvantage emphasized the need for more extensive urban-based cancer screening and education programs.

Original languageEnglish (US)
Pages (from-to)2755-2764
Number of pages10
Issue number12
StatePublished - Jun 15 2009


  • Health disparities
  • Neoplasms
  • Rural
  • Stage at diagnosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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