Overall survival based on oncologist density in the United States: A retrospective cohort study

The Association of Oncology Provider Density With Black-White Disparities in Cancer Mortality in US Counties

BACKGROUND

Black-White racial disparities in cancer mortality are well-documented in the US. Given the estimated shortage of oncologists over the next decade, understanding how access to oncology care might influence cancer disparities is of considerable importance. We aim to examine the association between oncology provider density in a county and Black-White cancer mortality disparities.

METHODS

An ecological study of 1048 US counties was performed. Oncology provider density was estimated using the 2013 National Plan and Provider Enumeration System data. Black:White cancer mortality ratio was calculated using 2014-2018 age-standardized cancer mortality rates from State Cancer Profiles. Linear regression with covariate adjustment was constructed to assess the association of provider density with (1) Black:White cancer mortality ratio, and (2) cancer mortality rates overall, and separately among Black and White persons.

RESULTS

The mean Black:White cancer mortality ratio was 1.12, indicating that cancer mortality rate among Black persons was on average 12% higher than that among White persons. Oncology provider density was significantly associated with greater cancer mortality disparities: every 5 additional oncology providers per 100 000 in a county was associated with a .02 increase in the Black:White cancer mortality ratio (95% CI: .007 to .03); however, the unexpected finding may be explained by further analysis showing that the relationship between oncology provider density and cancer mortality was different by race group. Every 5 additional oncologists per 100 000 was associated with a 1.6 decrease per 100 000 in cancer mortality rates among White persons (95% CI: -3.0 to -.2), whereas oncology provider density was not associated with cancer mortality among Black persons.

CONCLUSION

Greater oncology provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. Higher oncology provider density alone may not resolve cancer mortality disparities, thus attention to ensuring equitable care is critical.

Geographic disparities in access to immunotherapy clinical trials for metastatic melanoma

Survival outcomes for metastatic melanoma have drastically improved with the advent of immunotherapy. Access to ongoing immunotherapy clinical trials has become increasingly important to patients with advanced disease. We sought to quantify geographic disparities in access to these trials by U.S. division, region, urban/rural status, and median income. We searched ClinicalTrials.gov for interventional immunotherapy trials for metastatic melanoma from 2015 to 2021 and identified U.S. zip codes for each participating trial site. ArcGIS was used to calculate the one-way driving time from each zip code to the nearest treatment center. Melanoma burden in each zip code outside a 60 min driving radius was calculated by multiplying population by the corresponding state's cancer-specific mortality rate. χ² tests were used to test for significance between census regions, divisions, and urban vs. rural zip codes, while logistic regression was used to quantify risk of poor access with median income. Across 148 trials, 4844 treatment centers were located in 1102 unique zip codes. 9010 zip codes were located greater than one-hour driving time from the nearest clinical trial. Southern regions were most likely to have poor access of all regions (p < 0.001), and rural status also significantly correlated with poor access (p < 0.001). For every $10,000 increase in median income, the likelihood of a zip code being within 60 min from a trial increased by 1.315. While immunotherapy continue to improve survival outcomes for metastatic melanoma, geographic access to clinical trials investigating these therapies remains a challenge for a significant proportion of the U.S. population.

Oculofacial plastic surgeon distribution by county in the United States, 2021

PURPOSE

To characterize the number of oculofacial plastic surgeons (OPS) per county in the United States (U.S.).

METHODS

The 2021 public databases of the American Society of Ophthalmic Plastic and Reconstructive Surgery and the American Academy of Ophthalmology were used to identify all OPS in the U.S. Surgeon practice location was used to determine per capita physician density by county.

RESULTS

A total of 1184 OPS in the U.S. were identified. Three hundred forty-eight counties were served by at least one OPS whereas 2795 counties (89%), and two states, North Dakota and Wyoming, had no OPS. The average ratio of OPS to 100,000 population was 0.3572 (1 per 279,955). Of the counties with at least one OPS, the average was 0.5860 surgeons per 100,000 population (1 per 170,648), ranging from 0.0705 (1 per 1,418,440) to 11.26 (1 per 8,881) per 100,000. The counties with the greatest OPS density were Pitkin County, CO (1 per 8,881), San Juan County, WA (1 per 17,580), and Montour County, PA (1 per 18,231). Counties with the lowest density of those with at least one OPS were Bronx County, NY (1 per 1,418,238), San Bernardino County, Ca (1 per 1,090,037), and Gwinnett County, GA (1 per 936,329). The counties with the most OPS were Los Angeles County, CA (46), New York County, NY (38), and Cook County, IL (25).

CONCLUSIONS

Geographic disparities in OPS distribution exist in the U.S. Future investigations of OPS supply according to population and other characteristics for demand may be useful.