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Open AccessArticle

Continuous Rural-Urban Coding for Cancer Disparity Studies: Is It Appropriate for Statistical Analysis?

1
Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL 32601, USA
2
Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32601, USA
3
Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL 32601, USA
4
College of Medicine, University of Florida, Gainesville, FL 32601, USA
5
Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL 32601, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(6), 1076; https://doi.org/10.3390/ijerph16061076
Received: 26 February 2019 / Accepted: 21 March 2019 / Published: 26 March 2019
(This article belongs to the Special Issue Rural Health Disparities)
Background: The dichotomization or categorization of rural-urban codes, as nominal variables, is a prevailing paradigm in cancer disparity studies. The paradigm represents continuous rural-urban transition as discrete groups, which results in a loss of ordering information and landscape continuum, and thus may contribute to mixed findings in the literature. Few studies have examined the validity of using rural-urban codes as continuous variables in the same analysis. Methods: We geocoded cancer cases in north central Florida between 2005 and 2010 collected by Florida Cancer Data System. Using a linear hierarchical model, we regressed the occurrence of late stage cancer (including breast, colorectal, hematological, lung, and prostate cancer) on the rural-urban codes as continuous variables. To validate, the results were compared to those from using a truly continuous rurality data of the same study region. Results: In term of associations with late-stage cancer risk, the regression analysis showed that the use of rural-urban codes as continuous variables produces consistent outcomes with those from the truly continuous rurality for all types of cancer. Particularly, the rural-urban codes at the census tract level yield the closest estimation and are recommended to use when the continuous rurality data is not available. Conclusions: Methodologically, it is valid to treat rural-urban codes directly as continuous variables in cancer studies, in addition to converting them into categories. This proposed continuous-variable method offers researchers more flexibility in their choice of analytic methods and preserves the information in the ordering. It can better inform how cancer risk varies, degree by degree, over a finer spectrum of rural-urban landscape. View Full-Text
Keywords: late stage cancer; rural-urban codes; continuous variable; health disparities late stage cancer; rural-urban codes; continuous variable; health disparities
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Yaghjyan, L.; Cogle, C.R.; Deng, G.; Yang, J.; Jackson, P.; Hardt, N.; Hall, J.; Mao, L. Continuous Rural-Urban Coding for Cancer Disparity Studies: Is It Appropriate for Statistical Analysis? Int. J. Environ. Res. Public Health 2019, 16, 1076.

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