Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Rurality as an independent driver of cancer mortality: a systematic review and meta-analysis with implications for Australian cancer equity (146447)

Charlene Wright 1 , Lucy Leigh 2 3 , Sharina Riva 1 , Megan Crichton 4 , Helena Rodi 1 , Hannah Jongebloed 1 , Xueying Tang 1 , Elizabeth A Johnston 5 6 7 , Rebecca J Bergin 1 8 9 , Anna Chapman 1 , Fiona Crawford-Williams 10 , Laura Alston 11 12 , Nicolas N Hart 4 10 13 14 15 , Joel Rhee 16 , Lan Gao 17 , Kate M Gunn 18 19 , Harry Gasper 20 , Anna Ugalde 1 , Skye Marshall 1 4 21
  1. Institute for Health Transformation, Deakin University, Burwoord, Victoria, Australia
  2. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  3. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  4. Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  5. Viertel Cancer Research Centre, Cancer Council Qeensland, Brisbane, QLD, Australia
  6. School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
  7. School of Nursing and Midwife, Faculty of Health, Deakin University, Melbourne, VIC, Australia
  8. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
  9. Department of General Practice and Primary Care, University of Melbourne, Melbourne, Victoria, Australia
  10. Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
  11. Deakin Rural Health, Deakin University, Australia and Grampians Health, Western Victoria and the Grampians, VIC, Australia
  12. Research Unit, Colac Area Health, Colac, VIC, Australia
  13. Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney , Sydney, NSW, Australia
  14. Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
  15. Institute for Health Research, , University of Notre Dame Australia, Perth, WA, Australia
  16. Discipline of General Practice, School of Clinical Medicine, University of New South Wales, Kensington, NSW, Australia
  17. Deakin Health Economics, Institute for Health Transformation, Faculty of Health, , Deakin University, Melbourne, VIC, Australia
  18. IIMPACT in Health, College of Health, , Adelaide University, Adelaide, SA, Australia
  19. Adelaide University Rural Health, College of Health, , Adelaide University, Adelaide, SA, Australia
  20. Sunshine Coast University Private Hospital, Ramsay Health Care, Birtinya, QLD, Australia
  21. The Centre for Health Services Research, , The University of Queensland, Brisbane, QLD, Australia

Aims

A recent meta-analysis of crude survival data found that people living in rural Australia had 13% lower odds of cancer-specific survival than urban Australian cohorts, worsening with increasing geographic remoteness (up to 72% lower odds). Whether rurality independently contributes to this disadvantage, or reflects intersecting socioeconomic, demographic, and clinical factors, remains unclear. This study aimed to determine whether rurality is independently associated with cancer mortality after adjusting for confounders.

Methods

Four databases were searched from inception to October 2025 for cohort studies reporting hazard ratios (HRs) for cancer mortality by rurality status in Organisation for Economic Co-operation and Development (OECD) countries, with no restriction on participant or tumour type. HRs were pooled using random-effects meta-analysis in R using most-adjusted models and according to priority confounders (socioeconomic status, race/ethnicity, and cancer stage). Certainty was assessed using GRADE.

Results

Fifty-two studies were included, 21% Australian cohorts. After adjustment for confounders, rurality remained independently associated with higher cancer-specific (HR 1.08 [95%CI 1.05, 1.12]; GRADE low) and all-cause (HR 1.05 [95%CI 1.02, 1.08]; GRADE low) mortality. In Australian cohorts, rural residence carried a 19% higher hazard of cancer-specific mortality (HR 1.19 [95%CI 1.17, 1.22]; GRADE high), a disadvantage not mirrored in North American cohorts (HR 1.03 [95%CI 0.99, 1.07]). For rare and less common cancers, rural residence carried a 21% higher hazard of all-cause mortality (HR 1.21 [95%CI 1.04, 1.40]; GRADE high). Geographical remoteness, socioeconomic status, and race/ethnicity consistently modified the association between rurality and mortality.

Conclusions

Rural residence was independently associated with higher cancer mortality after adjustment for confounders, and this disadvantage was more pronounced in Australian cohorts and for rare and less common cancers. These findings support Australian cancer policy, service planning and implementation strategies that prioritise rural and remote populations and ensure equitable access to best-practice care.