abstract: 'Background Ewing Sarcoma (ES) is an aggressive tumor affecting

  adolescents and young adults. Prior studies investigated the association

  between rurality and outcomes, although there is a paucity of literature

  focusing on ES. Objective This study aims to determine whether ES

  patients in rural areas are subject to adverse outcomes. Methods This

  study utilized the Surveillance, Epidemiology, and End Results (SEER)

  database. A Poisson regression model was used with controls for race,

  sex, median county income, and age to determine the association between

  rurality and tumor size. A multivariate Cox Proportional Hazard Model

  was utilized, controlling for age, race, gender, income, and tumor size.

  Results There were 868 patients eligible for analysis, with a mean age

  of 14.14 years. Of these patients, 97 lived in rural counties (11.18\%).

  Metropolitan areas had a 9.50\% smaller tumor size (p<0.0001), compared

  to non-metropolitan counties. Patients of Black race had a 14.32\%

  larger tumor size (p<0.0001), and male sex was associated with a 15.34\%

  larger tumor size (p<0.0001). The Cox Proportional Hazard model

  estimated that metropolitan areas had a 36\% lower risk of death over

  time, compared to non-metropolitan areas (HR: 0.64, p <= 0.04).

  Conclusion Patients in metropolitan areas had a smaller tumor size at

  time of diagnosis and had a more favorable survival rate for

  cancer-specific mortality compared to patients residing in rural areas.

  Further work is needed to examine interventions to reduce this

  discrepancy and investigate the effect of extremely rural and urban

  settings and why racial disparities occur.'
author: Alsoof, Daniel and Kasthuri, Viknesh and Homer, Alexander and Glueck, Jacob
  and McDonald, Christopher L. and Kuris, Eren O. and Daniels, Alan H.
author_list:
- family: Alsoof
  given: Daniel
- family: Kasthuri
  given: Viknesh
- family: Homer
  given: Alexander
- family: Glueck
  given: Jacob
- family: McDonald
  given: Christopher L.
- family: Kuris
  given: Eren O.
- family: Daniels
  given: Alan H.
da: '2023-09-28'
doi: 10.52965/001c.74118
eissn: 2035-8164
files: []
issn: 2035-8237
journal: ORTHOPEDIC REVIEWS
keywords-plus: RACIAL DISPARITIES; HOSPITAL VOLUME; CHEMOTHERAPY; ACCESS; CARE
language: English
number-of-cited-references: '27'
papis_id: d0a5dd860c709e4af1d35900ae091773
ref: Alsoof2023countyrurality
times-cited: '0'
title: County Rurality is Associated with Increased Tumor Size and Decreased Survival
  in Patients with Ewing Sarcoma
type: Article
unique-id: WOS:000998624200003
usage-count-last-180-days: '0'
usage-count-since-2013: '0'
volume: '15'
web-of-science-categories: Orthopedics
year: '2023'