Disparities in geographic access to medical oncologists.
Disparities in geographic access to medical oncologists.
复制标题
接触肿瘤科医生的地域差异。
DOI：
10.1111/1475-6773.13991
复制
发表时间：
2022
影响因子：
3.4
通讯作者：
Drake,Coleman
中科院分区：
文献类型：
--
作者：
Muluk,Sruthi;Sabik,Lindsay;Chen,Qingwen;Jacobs,Bruce;Sun,Zhaojun;Drake,Coleman
目的本研究的目的是确定在诊断时获得医学肿瘤学家的地理差异。数据来源/研究设置2014 - 2016年宾夕法尼亚州癌症登记处（PCR）、2019年CMS基础提供者登记文件（BPEF）、2018年CMS医师比较、2010年城乡通勤区域代码（RUCA）和2015年区域剥夺指数（ADI）。研究设计：采用空间回归来估计肿瘤内科医生的地理可及性与人口统计学特征之间的关联（采用增强的两步浮动集水区测量法测量）。在2019年CMS BPEF中确定内科肿瘤学家，并与2018年CMS医师比较合并。使用OpenCage Geocoder将提供商地址转换为经纬度。2014-2016年，各人口普查区新诊断的癌症患者均被PCR识别。使用2010年RUCA代码和2015年ADI，根据乡村性和社会经济状况对人口普查区进行分类。主要发现：与城市地区相比，大城市和农村地区的空间可及性比率（SPARs）分别低6.29 （95% CI - 16.14 ~ 3.57）和14.76 （95% CI - 25.14 ~ 4.37）。相对于第一个四分位数，处于第四个ADI四分位数（最高劣势）的SPAR降低12.41 （95% CI - 19.50至- 5.33）。人口普查区非白人人口从第25百分位数（1.3%）到第75百分位数（13.7%）的差异与较高的13.64 SPAR相关（系数= 1.10,95% CI 11.89至15.29;p< 0.01），大致相当于与生活在第四个ADI四分位数相关的不利因素，其中非白人人口集中。结论农村和低社会经济地位与肿瘤医生的地理可及性较低有关。面积剥夺与地理可及性之间的负相关程度与较大的非白人人口与可及性之间的正相关程度相似。旨在增加地理上获得保健的机会的政策应认识到农村和社会经济地位。
ObjectiveThe objective of this study is to identify disparities in geographic access to medical oncologists at the time of diagnosis.Data Sources/Study Setting2014–2016 Pennsylvania Cancer Registry (PCR), 2019 CMS Base Provider Enrollment File (BPEF), 2018 CMS Physician Compare, 2010 Rural‐Urban Commuting Area Codes (RUCA), and 2015 Area Deprivation Index (ADI).Study DesignSpatial regressions were used to estimate associations between geographic access to medical oncologists, measured with an enhanced two‐step floating catchment area measure, and demographic characteristics.Data Collection/Extraction MethodsMedical oncologists were identified in the 2019 CMS BPEF and merged with the 2018 CMS Physician Compare. Provider addresses were converted to longitude‐latitude using OpenCage Geocoder. Newly diagnosed cancer patients in each census tract were identified in the 2014–2016 PCR. Census tracts were classified based on rurality and socioeconomic status using the 2010 RUCA Codes and the 2015 ADI.Principal FindingsLarge towns and rural areas were associated with spatial access ratios (SPARs) that were 6.29 lower (95% CI −16.14 to 3.57) and 14.76 lower (95% CI −25.14 to −4.37) respectively relative to urban areas. Being in the fourth ADI quartile (highest disadvantage) was associated with a 12.41 lower SPAR (95% CI −19.50 to −5.33) relative to the first quartile. The observed difference in a census tract's non‐White population from the 25th (1.3%) to the 75th percentile (13.7%) was associated with a 13.64 higher SPAR (Coefficient = 1.10, 95% CI 11.89 to 15.29;p< 0.01), roughly equivalent to the disadvantage associated with living in the fourth ADI quartile, where non‐White populations are concentrated.ConclusionsRurality and low socioeconomic status were associated with lower geographic access to oncologists. The negative association between area deprivation and geographic access is of similar magnitude to the positive association between larger non‐White populations and access. Policies aimed at increasing geographic access to care should be cognizant of both rurality and socioeconomic status.