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

Background: 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).Methods: 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.Results: 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 scorematched 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).Conclusions: 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.