The effect of physician density on colorectal cancer stage at diagnosis: causal inference methods for spatial data applied on regional-level data

International Journal of Health Geographics

Research

Knut Reidar Wangen¹  Dajana Draganic¹ 

[1] Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway;

关键词: Colorectal cancer;    Preventive services;    General practitioners;    Specialists;    Regional variations;    Physician density;    Causal methods for spatial data;    Bayesian statistics;   

DOI  :  10.1186/s12942-023-00323-w

 received in 2022-10-14, accepted in 2023-01-04,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe early detection of colorectal cancer (CRC) through regular screening decreases its incidence and mortality rates and improves survival rates. Norway has an extremely high percentage of CRC cases diagnosed at late stages, with large variations across municipalities and hospital catchment areas. This study examined whether the availability of physicians related to CRC primary diagnosis and preoperative investigations, or physician density, contributes to the observed geographical differences in late-stage incidence rates.MethodMunicipality-level data on CRC stage at diagnosis were obtained from the Cancer Registry of Norway for the period 2012–2020. Physician density was calculated as the number of physicians related to CRC investigations, general practitioners (GPs) and specialists per 10,000 people, using physician counts per municipality and hospital areas from Statistics Norway. The relationship was examined using a novel causal inference method for spatial data—neighbourhood adjustment method via spatial smoothing (NA approach)—which allowed for studying the region-level effect of physician supply on CRC outcome by using spatially referenced data and still providing causal relationships.ResultsAccording to the NA approach, an increase in one general practitioner per 10,000 people will result in a 3.6% (CI −0.064 to −0.008) decrease in late-stage CRC rates. For specialists, there was no evidence of a significant correlation with late-stage CRC distribution, while for both groups, GPs and specialists combined, an increase of 1 physician per 10,000 people would be equal to an average decrease in late-stage incidence rates by 2.79% (CI −0.055 to −0.001).ConclusionThe study confirmed previous findings that an increase in GP supply will significantly improve CRC outcomes. In contrast to previous research, this study identified the importance of accessibility to both groups of physicians—GPs and specialists. If GPs encounter insufficient workforces in hospitals and long delays in colonoscopy scheduling, they will less often recommend colonoscopy examinations to patients. This study also highlighted the efficiency of the novel methodology for spatially referenced data, which allowed us to study the effect of physician density on cancer outcomes within a causal inference framework.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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