Associations of physician supplies with colon cancer care in Ontario and California, 1996 to 2006.
Dig Dis Sci
; 56(2): 523-31, 2011 Feb.
Article
in En
| MEDLINE
| ID: mdl-20521113
ABSTRACT
BACKGROUND:
This study examined the differential effects of physician supplies on colon cancer care in Ontario and California. The associations of physician supplies with colon cancer stage at diagnosis, receipt of surgery and adjuvant chemotherapy, and 5-year survival were observed within each country and compared between-country.METHODS:
Random samples of Ontario and California cancer registries provided 2,461 and 2,200 colon cancer cases that were diagnosed between 1996 and 2000, and followed until 2006. Both registries included data on the stage of disease at the time of diagnosis, receipt of cancer-directed surgery, receipt of adjuvant chemotherapy, and survival. Census tract-level data on low-income prevalence were, respectively, taken from 2001 and 2000 Canadian and United States population censuses. County-level primary care physician and gastroenterologist densities were computed for the same years.RESULTS:
Significant income-adjusted, gastroenterologist density threshold effects (2.0 or more vs. less than 2.0 per 100,000 inhabitants) were observed for early diagnosis (OR = 1.57) and 5-year survival (OR = 1.63) in Ontario, but not in California. Significant incremental threshold effects of primary care physician densities on chemotherapy receipt (8.0 and 9.0 or more per 10,000 inhabitants, respective ORs of 1.79 and 2.37) were also only observed in Ontario.CONCLUSIONS:
These colon cancer care findings support the theory that while personal economic resources are more predictive in America, community-level resources such as physician supplies are more predictive of health care access and effectiveness in Canada.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Physicians
/
Colonic Neoplasms
/
Delivery of Health Care
Type of study:
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Aspects:
Determinantes_sociais_saude
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Dig Dis Sci
Year:
2011
Document type:
Article
Affiliation country:
Canada