Rural-Urban Differences in Access to Specialist Providers of Colorectal Cancer Care in the United States A Physician Workforce Issue
Rural-Urban Differences in Access to Specialist Providers of Colorectal Cancer Care in the United States A Physician Workforce Issue
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DOI：
10.1001/jamasurg.2013.5062
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发表时间：
2014-06-01
期刊：
影响因子：
16.9
通讯作者：
Hayanga, Awori J.
中科院分区：
文献类型：
--
作者：
Aboagye, Jonathan K.;Kaiser, Heather E.;Hayanga, Awori J.
目的通过比较美国城乡结直肠癌筛查和治疗服务提供者的分布，探讨结直肠癌筛查和治疗中可能存在的差异。设计、设置和参与者一项基于人口的回溯性研究，使用从2009年地区资源文件中获得的数据，针对每个县内的所有美国人口。主要结果和措施美国的县被分类为农村或城市，使用城乡连续编码作为我们的主要暴露。每个县每10万人中胃肠病医生、普通外科医生和放射肿瘤学家的比例被估计为主要结果。调整县级社会经济变量，如女性比例、黑人比例、无保险人口比例、高中文凭比例、家庭收入中位数等，进行多元线性回归分析，估计各类医疗服务提供者在城乡之间的相对密度。一项未经调整的分析显示，在城市与农村相比，每10万人中胃肠病医生、普通外科医生和放射肿瘤学家的密度增加。多变量分析显示胃肠病科医生的密度显著增加(1.63；95%CI，1.40-1.85；P
OBJECTIVE To examine the disparities that may exist in colorectal cancer screening and treatment by comparing the distribution of providers of these services in rural and urban counties in the United States.DESIGN, SETTING, AND PARTICIPANTS A retrospective population-based study using data obtained from the 2009 Area Resource File for the entire US population within each county.MAIN OUTCOMES AND MEASURES Counties in the United States were categorized as rural or urban using rural-urban continuum codes as our primary exposure. The proportion of gastroenterologists, general surgeons, and radiation oncologists per 100 000 people in each county was estimated as primary outcomes. Multivariate linear regression analysis adjusted for county-level socioeconomic variables, such as percentages of females, blacks, population without insurance, those with a high school diploma, and median household income, to estimate the relative density of each category of these providers between urban and rural counties.RESULTS In total, 3220 counties were identified, comprising 1807 rural and 1413 urban counties. An unadjusted analysis showed an increased density of gastroenterologists, general surgeons, and radiation oncologists per 100 000 people in urban vs rural counties. A multivariable analysis revealed a significantly higher density of gastroenterologists (1.63; 95% CI, 1.40-1.85; P