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

Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of ne...

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Autores principales:	Sudeep K Siddappa Malleshappa, Smith Giri, Smit Patel, Tapan Mehta, Leonard Appleman, Scott F Huntington, Vida Passero, Rahul A Parikh, Kathan D Mehta
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/20388de4ad774ff2b008984ba9e7a1a3
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spelling	oai:doaj.org-article:20388de4ad774ff2b008984ba9e7a1a32021-12-02T20:05:38ZOverall survival based on oncologist density in the United States: A retrospective cohort study.1932-620310.1371/journal.pone.0250894https://doaj.org/article/20388de4ad774ff2b008984ba9e7a1a32021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0250894https://doaj.org/toc/1932-6203Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists' recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9-6.5, 6.5-8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients' median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97-1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.Sudeep K Siddappa MalleshappaSmith GiriSmit PatelTapan MehtaLeonard ApplemanScott F HuntingtonVida PasseroRahul A ParikhKathan D MehtaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0250894 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sudeep K Siddappa Malleshappa Smith Giri Smit Patel Tapan Mehta Leonard Appleman Scott F Huntington Vida Passero Rahul A Parikh Kathan D Mehta Overall survival based on oncologist density in the United States: A retrospective cohort study.
description	Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists' recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9-6.5, 6.5-8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients' median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97-1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.
format	article
author	Sudeep K Siddappa Malleshappa Smith Giri Smit Patel Tapan Mehta Leonard Appleman Scott F Huntington Vida Passero Rahul A Parikh Kathan D Mehta
author_facet	Sudeep K Siddappa Malleshappa Smith Giri Smit Patel Tapan Mehta Leonard Appleman Scott F Huntington Vida Passero Rahul A Parikh Kathan D Mehta
author_sort	Sudeep K Siddappa Malleshappa
title	Overall survival based on oncologist density in the United States: A retrospective cohort study.
title_short	Overall survival based on oncologist density in the United States: A retrospective cohort study.
title_full	Overall survival based on oncologist density in the United States: A retrospective cohort study.
title_fullStr	Overall survival based on oncologist density in the United States: A retrospective cohort study.
title_full_unstemmed	Overall survival based on oncologist density in the United States: A retrospective cohort study.
title_sort	overall survival based on oncologist density in the united states: a retrospective cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/20388de4ad774ff2b008984ba9e7a1a3
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_version_	1718375408699703296

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

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