Geographic disparities in residential proximity to colorectal and cervical cancer care providers
Geographic disparities in residential proximity to colorectal and cervical cancer care providers
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DOI：
10.1002/cncr.32594
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发表时间：
2019-11-08
期刊：
影响因子：
6.2
通讯作者：
Eberth, Jan M.
中科院分区：
文献类型：
--
作者：
Hung, Peiyin;Deng, Songyuan;Eberth, Jan M.
结直肠癌和宫颈癌的持续城乡差异引起了人们对获得治疗提供者的关注。据作者所知，很少有人知道关于住宅接近癌症专家的城乡差异。方法使用2018年医生比较关于医生执业地点的数据和2012年至2016年美国社区调查，目前的研究估计了从每个住宅邮政编码列表区（ZCTA）质心到最近的癌症提供者的驾驶距离。内科肿瘤学、放射肿瘤学、外科肿瘤学、普通外科学、妇科肿瘤学和结肠直肠外科学。使用人口加权多变量逻辑回归，作者分析了ZCTA水平特征与驾驶距离>60英里到每种类型的专家之间的关联。ZCTA水平的住宅农村定义使用城乡通勤区域代码。近五分之一的美国农村居民居住在距离医学肿瘤学家60英里以上的地方。对于癌症外科医生来说，到最近的癌症护理提供者的旅行距离的城乡差异大幅增加;超过一半的农村居民需要旅行60英里才能到达妇科肿瘤学家，而城市居民则需要8英里。居住在ZCTA内的贫困率较高的个人，美国印第安人/阿拉斯加原住民种族，和/或位于南部和西部地区的人比他们的同行更有可能距离上述任何提供者超过60英里。结论农村低收入居民到达癌症专家所需的大量旅行距离应促使政策行动，以增加数百万农村居民获得专业癌症护理的机会。
Background Persistent rural-urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural-urban differences in residential proximity to cancer specialists. Methods Using the 2018 Physician Compare data concerning physician practice locations and the 2012 to 2016 American Community Survey, the current study estimated the driving distance from each residential zip code tabulation area (ZCTA) centroid to the nearest cancer provider of the following medical specialties involved in treating patients with colorectal and cervical cancer: medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology, and colorectal surgery. Using population-weighted multivariable logistic regression, the authors analyzed the associations between ZCTA-level characteristics and driving distances >60 miles to each type of specialist. ZCTA-level residential rurality was defined using rural-urban commuting area codes. Results Nearly 1 in 5 rural Americans lives >60 miles from a medical oncologist. Rural-urban differences in travel distances to the nearest cancer care provider(s) increased substantially for cancer surgeons; greater than one-half of rural residents were required to travel 60 miles to reach a gynecological oncologist, compared with 8 miles for their urban counterparts. Individuals residing within ZCTAs with a higher poverty rate, those of American Indian/Alaska Native ethnicity, and/or were located in the South and West regions were more likely than their counterparts to be >60 miles away from any of the aforementioned providers. Conclusions The substantial travel distances required for rural, low-income residents to reach a cancer specialist should prompt a policy action to increase access to specialized cancer care for millions of rural residents.