Rural-urban disparities in musculoskeletal functional limitation among cancer patients in the United States.

Abstract

e13799 Background: As cancer survivorship increases, long-term physical function has emerged as a critical determinant of quality of life and independence. Musculoskeletal impairment related to cancer treatment, metastatic disease, and deconditioning may be exacerbated by disparities in access to rehabilitative and orthopaedic care. Rural populations face well-documented barriers to specialty care, yet rural-urban differences in physical function among cancer patients remain poorly characterized at a national level. Thus, we evaluated the association between rural residence and functional limitation among U.S. adults with cancer history. Methods: We analyzed pooled 2018–2024 data from the National Health Interview Survey, restricting the sample to adults with history of cancer. Rural populations were defined as living in a nonmetropolitan county. Functional limitation was defined as difficulty walking or climbing steps (“some difficulty”, “a lot of difficulty”, or “cannot do at all”). Covariates included age, sex, ethnicity, health insurance, private health insurance, and medical history (arthritis, asthma, coronary heart disease, prior myocardial infarction, chronic obstructive pulmonary disease). Sample weights were applied to account for complex survey design. A multivariable logistic regression was estimated. Results: 26,117 cancer patients were included (unweighted), 17.2% (95% CI: 16.7-17.8) of which resided in rural counties. Average age was 67.0 years old (66.5-67.6). 44.3% (43.6-45.0) of patients were male. 36.6% (35.9-37.3) of patients reported functional limitation overall; 42.4% (40.7-44.1) of rural patients reported limitation versus 35.8% (35.0-36.7) of urban patients. In multivariable logistic regression, cancer patients living in a rural county had 1.20 (1.10-1.31) times increased odds of reporting functional limitation (p < 0.001). Conclusions: Rural residence is independently associated with worse physical function among U.S. cancer patients, even after adjustment for demographic, socioeconomic, and medical factors. These findings suggest that geographic disparities in access to rehabilitative, orthopaedic, and survivorship care may contribute to long-term functional impairment. Targeted interventions to improve access to musculoskeletal and rehabilitation services in rural communities may reduce disability and improve survivorship outcomes among cancer patients.