The association between county-level surgeon density and esophageal and gastric cancer mortality

Abstract

Background: Surgical resection plays an integral part in the curative treatment of esophageal (EC) and gastric cancer (GC). The impact of the allocation of surgeons at the county level on these cancer outcomes is unclear. Our aims were to examine the effect of surgeon density on EC and GC mortality and to compare the relative roles of thoracic and general surgeons on outcomes.

Methods: Using county-level data from the Area Resource File, we constructed multivariate regression models to explore the effect of thoracic and general surgeon density on EC and GC mortality, adjusting for cancer incidence rate, county-level, socioeconomic factors and health care resource metrics.

Results: In total, 663 and 539 counties were analyzed for EC and GC, respectively: Mean EC and GC mortality rates were 4.95 and 4.07; mean thoracic and general surgeon density were 6 and 50 per 100,000 people, respectively. When compared to counties with no thoracic surgeons, those with at least one thoracic surgeon had reduced EC mortality. For GC, counties with one or more general surgeons also had decreased deaths when compared with those without any general surgeons. While increasing the density of surgeons beyond ten only yielded minimal improvements in EC mortality, this resulted in significant further reductions in GC mortality.

Conclusions: Mortality from GC appears to be more susceptible to the benefits of increased surgeon density. For EC, a strategic policy of allocating health resources and distributing the surgical workforce proportionally across counties will be best able to optimize outcomes at the population-based level.