Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 May 20;28(15):2499-504.
doi: 10.1200/JCO.2009.26.9597. Epub 2010 Apr 20.

Urologist density and county-level urologic cancer mortality

Anobel Y Odisho  1 , Matthew R Cooperberg, Vincent Fradet, Ardalan E Ahmad, Peter R Carroll
Affiliations

Urologist density and county-level urologic cancer mortality

Anobel Y Odisho et al. J Clin Oncol. .

Abstract

Purpose: The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing urologist density on local prostate, bladder, and kidney cancer mortality.

Patients and methods: Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure.

Results: For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties that had more than zero urologists (16% to 22% reduction for prostate cancer, 17% to 20% reduction for bladder cancer, and 8% to 14% reduction for kidney cancer with increasing urologist density) relative to zero urologists. However, increasing density greater than two urologists per 100,000 people had no statistically significant impact on mortality for any of the tumors studied.

Conclusion: The presence of a urologist is associated with lower mortality for urologic cancers in that county, but increasing urologist density does not yield further improvements. Therefore, a nuanced and geographically aware policy toward the size and distribution of the future work force is most likely to provide the greatest population-level improvement in cancer mortality outcomes.

PubMed Disclaimer

Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Distribution of urologist density in metropolitan and nonmetropolitan counties.
Fig 2.
Fig 2.
Change in cancer mortality with increasing urologist density in a county using data from multivariate models. (A) prostate; (B) bladder; (C) kidney.
See this image and copyright information in PMC

References

    1. US Census Bureau. Population Projections. http://www.census.gov/population/www/projection/index.html.
    1. Cooper RA. The coming era of too few physicians. Bull Am Coll Surg. 2008;93:11–18. - PubMed
    1. Cooper RA. The future of specialty care in the US. Nat Clin Pract Rheumatol. 2008;4:333. - PubMed
    1. Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. Int J Health Serv. 2007;37:111–126. - PubMed
    1. Phillips RL, Dodoo MS, Green LA. Adding more specialists is not likely to improve population health: Is anybody listening? Health Aff (Millwood) 2005;(suppl):W5-111–W5-114. - PubMed

Publication types