1. Survivors of head and neck cancer (HNC) from rural American counties had double the rate of suicides compared to HNC survivors from metropolitan and urban counties.
Evidence Rating Level: 2 (Good)
Suicide has been in the top 10 leading causes of death in the United States since 2008. As well, the suicide rate is twice greater among cancer survivors, and 4 times as great with head and neck cancer (HNC) survivors. There is currently not much information on how living in an urban or rural setting may affect suicide rates for HNC survivors. This data is imperative due to the fact that cancer survival is lower in rural areas, and there is less access to cancer and mental health services rurally. The current study compared the incidence of suicide across metropolitan, urban, and rural counties for 134,510 HNC patients in the USA, from the years 2000 to 2016. Rural counties were defined as those with a population of less than 2500 people. The study found that In metropolitan counties, there were 59.2 suicides per 100,000 person-years; in urban counties, there were 64.0 per 100,000 person-years; and in rural counties, there were 126.7 per 100,000 person-years. Through cumulative incidence analyses, rural patients had the greatest incidence of suicide. Compared to those in rural counties, urban and metropolitan counties had around 50% the suicide risk (hazards ratio 0.51, 95% CI 0.28-0.92 and HR 0.48, 95% CI 0.28-0.82 respectively). Overall, this study underlies the need for increased access to mental health services, especially for HNC survivors.
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