该研究的主要目的是确定农村居住对于美国医疗保险（Medicare）受益者肺癌手术治疗的接受率和治疗结果的影响。肺癌是美国导致癌症相关死亡的主要原因，而农村患者的死亡率比城市患者高出20%。目前人们对于不同地区癌症治疗过程中不平等的原因了解不足。本研究统计分析2015-2018年的美国医疗保险索赔数据，共筛选出126,352名老年肺癌患者，其中在农村、城市等区域的居住地根据Rural Urban Commuting Area（RUCA）代码进行划分。多元逻辑回归模型分别评估了住所对以下三个方面的影响：1）癌症相关手术的接受率，2）确诊到手术时间的长短，3）手术后的结果。结果显示，城市居民接受癌症相关手术的比例（22.1%）高于省会城市（18.7%）、小城镇（17.5%）和农村地区（17.8%）（P < 0.001）。相较于城市患者，省会城市、小城镇和农村患者的确诊到手术时间更长。多元模型发现，非大都市地区的居住因素与癌症相关手术和微小侵袭性手术的接受率较低有关。非大都市地区的居住因素与手术后急诊就诊的概率较高有关。因此，农村地区的居民接受癌症相关手术的概率较低，且需要更长时间来完成手术；同时，微小侵袭性手术被使用的情况也较少。此外，居住在非大都市地区的患者常常需要后续的急诊就诊。因此，加强非大都市地区患者的手术时间和术后护理协调，可以提高癌症治疗的效果。 版权所有©2021 Wolters Kluwer Health，Inc.。

The primary objective of this study was to determine the influence of rural residence on access to and outcomes of lung cancer-directed surgery for Medicare beneficiaries.Lung cancer is the leading cause of cancerrelated death in the United States and rural patients have 20% higher mortality. Drivers of rural disparities along the continuum of lung cancercare delivery are poorly understood.Medicare claims (2015-2018) were used to identify 126,352 older adults with an incident diagnosis of nonmetastatic lung cancer. Rural Urban Commuting Area codes were used to define metropolitan, micropolitan, small town, and rural site of residence. Multivariable logistic regression models evaluated influence of place of residence on 1) receipt of cancer-directed surgery, 2) time from diagnosis to surgery, and 3) postoperative outcomes.Metropolitan beneficiaries had higher rate of cancer-directed surgery (22.1%) than micropolitan (18.7%), small town (17.5%), and isolated rural (17.8%) (P < 0.001). Compared to patients from metropolitan areas, there were longer times from diagnosis to surgery for patients living in micropolitan, small, and rural communities. Multivariable models found nonmetropolitan residence to be associated with lower odds of receiving cancer-directed surgery and MIS. Nonmetropolitan residence was associated with higher odds of having postoperative emergency department visits.Residence in nonmetropolitan areas is associated with lower probability of cancer-directed surgery, increased time to surgery, decreased use of MIS, and increased postoperative ED visits. Attention to timely access to surgery and coordination of postoperative care for nonmetropolitan patients could improve care delivery.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.