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Published on: May 12, 2019
Urologist density and county-level urologic cancer mortality
Anobel Y Odisho1, Matthew R Cooperberg, Vincent Fradet
1Department of Urology, University of California, San Francisco, San Francisco, CA 94143-1695, USA. anobel.odisho@ucsf.edu
Summary
Having a urologist significantly lowers cancer deaths in counties, but more urologists don't further reduce mortality. Geographic distribution of urologists is key for improving cancer care outcomes.
Area of Science:
- Urology
- Public Health
- Cancer Research
Background:
- Surgical workforce distribution varies significantly across US counties.
- The impact of unequal access to care on cancer outcomes remains unclear.
- Urologists are key providers for urologic cancers and are unevenly distributed.
Purpose of the Study:
- To determine the effect of increasing urologist density on local prostate, bladder, and kidney cancer mortality.
- To investigate the relationship between urologist availability and cancer-specific mortality rates.
Main Methods:
- County-level data from multiple sources (Area Resource File, US Census, NCI, CDC) were utilized.
- Regression models were developed to analyze cancer mortality.
- Models controlled for urologist density, demographics, socioeconomic factors, and healthcare infrastructure.
Main Results:
- Counties with at least one urologist showed significant reductions in prostate (16-22%), bladder (17-20%), and kidney (8-14%) cancer mortality.
- Increasing urologist density beyond two per 100,000 people did not significantly impact mortality for any studied cancer.
- A threshold effect was observed, where the presence of a urologist mattered, but higher density did not offer additional benefits.
Conclusions:
- The presence of a urologist is associated with reduced urologic cancer mortality at the county level.
- Increased urologist density beyond a certain point does not lead to further improvements in cancer mortality.
- Geographically informed workforce policies are essential for optimizing population-level cancer outcomes.
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