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Rural representation of the surveillance, epidemiology, and end results database

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Abstract

Purpose

SEER data are widely used to study rural–urban disparities in cancer. However, no studies have directly assessed how well the rural areas covered by SEER represent the broader rural United States.

Methods

Public data sources were used to calculate county level measures of sociodemographics, health behaviors, health access and all cause cancer incidence. Driving time from each census tract to nearest Commission on Cancer certified facility was calculated and analyzed in rural SEER and non-SEER areas.

Results

Rural SEER and non-SEER counties were similar with respect to the distribution of age, race, sex, poverty, health behaviors, provider density, and cancer screening. Overall cancer incidence was similar in rural SEER vs non-SEER counties. However, incidence for White, Hispanic, and Asian patients was higher in rural SEER vs non-SEER counties. Unadjusted median travel time was 53 min (IQR 34–82) in rural SEER tracts and 54 min (IQR 35–82) in rural non-SEER census tracts. Linear modeling showed shorter travel times across all levels of rurality in SEER vs non-SEER census tracts when controlling for region (Large Rural: 13.4 min shorter in SEER areas 95% CI 9.1;17.6; Small Rural: 16.3 min shorter 95% CI 9.1;23.6; Isolated Rural: 15.7 min shorter 95% CI 9.9;21.6).

Conclusions

The rural population covered by SEER data is comparable to the rural population in non-SEER areas. However, patients in rural SEER regions have shorter travel times to care than rural patients in non-SEER regions. This needs to be considered when using SEER-Medicare to study access to cancer care.

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Code availability

STATA v16.0 was used for statistical analyses. ArcGIS was used for travel time calculations. Analysis code is available on reasonable request.

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Acknowledgments

The authors would like to acknowledge May Kuo, PhD for her assistance with the study design. Dr. Herb is partially supported by a National Service Research Award Pre-Doctoral/Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032

Funding

Dr. Herb is partially supported by a National Service Research Award Pre-Doctoral/Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. 5T32 HS000032.

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Authors and Affiliations

  1. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Joshua Herb & Karyn Stitzenberg

  2. University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Rachael Wolff & Philip McDaniel

  3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Mark Holmes & Jennifer Lund

  4. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

    Joshua Herb & Mark Holmes

Authors
  1. Joshua Herb
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  2. Rachael Wolff
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  3. Philip McDaniel
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  4. Mark Holmes
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  5. Jennifer Lund
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  6. Karyn Stitzenberg
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JH, RW and PMcD. The first draft of the manuscript was written by JH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joshua Herb.

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Conflict of interest

The authors have no conflicts of interest to disclose. Dr. Herb has disclosed his funding source above.

Ethical approval

This is an observational study and the data used in this study are deidentified and publicly available. The University of North Carolina Institutional Review Board deemed the study exempt as this is a secondary data analysis of deidentified data.

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Herb, J., Wolff, R., McDaniel, P. et al. Rural representation of the surveillance, epidemiology, and end results database. Cancer Causes Control 32, 211–220 (2021). https://doi.org/10.1007/s10552-020-01375-0

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  • DOI: https://doi.org/10.1007/s10552-020-01375-0

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