Abstract 6219: Population-based analysis of rurality and its impact on survival in gastric adenocarcinoma

Abstract Background: Despite growing efforts to understand the impact of rurality on cancer survival outcomes, significant gaps remain on how it influences prognosis within specific cancer types. In this study, we examine how residential location (rural vs urban) affects survival outcomes for patients diagnosed with gastric adenocarcinoma. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 56, 371 patients with gastric adenocarcinoma between 2007 and 2020, who were 18 years or older at diagnosis and had complete data for all analyzed variables. Demographics of patients living in rural vs urban areas were compared using Wilcoxon rank sum or chi-squared testing for categorical or continuous variables, respectively. The impact of area of residence on cancer-specific survival (CSS) was assessed through Kaplan-Meier and Cox proportional hazards analysis. A multivariable Weibull regression survival model was used to control for potential confounding covariates. Results: Most patients lived in urban areas (88.9% vs 11.1%). There were no significant differences in age and stage at diagnosis between rural and urban populations. Rural patients tended to be male (p < 0.001) and non-Hispanic White (p < 0.001) with lower median household income (p < 0.001). Patients residing in rural areas had significantly worse CSS [hazard ratio (HR) = 1.158; 95% CI: 1.122-1.195; p < 0.0001]. When stratified by race, the prognostic impact of rurality was absent in Non-Hispanic Black patients (p = 0.62). When adjusting for age, sex, race, stage, and income, rurality remained an independent predictor of survival [HR = 1.064; 95% CI: 1.026-1.103; p = 0.0007]. Conclusion: Rurality is associated with worse prognosis in patients with gastric adenocarcinoma. Further research is needed to understand the mechanisms of how area of residence contributes to outcome disparities to identify targeted interventions. Citation Format: Nicole M. Hwang, Matthew Dixon. Population-based analysis of rurality and its impact on survival in gastric adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6219.