Associations of Physician Supplies with Colon Cancer Care in Ontario and California, 1996 to 2006

Gorey, Kevin M.; Luginaah, Isaac; Bartfay, Emma; Fung, Karen Y.; Holowaty, Eric J.; Wright, Frances C.; Hamm, Caroline; Kanjeekal, Sindu M.; Balagurusamy, Madhan K

doi:10.1007/s10620-010-1284-4

Cited by 13 publications

(17 citation statements)

References 39 publications

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“…This finding is in line with current literature: A study conducted within Adelaide (Australia) found similar distribution patterns: 16% of residents were reported to live in an area of GP shortage within Adelaide boundaries [26]. An unbalanced distribution of physicians was further reported for Auckland (New Zealand) [27] and Toronto (Canada), where the authors reported a range of 6.18–12.42 GPs per 10^4 residents for the city districts of Toronto [28]. In our study, the number of FTE per 10^4 residents ranged between 1.80–43.98 and therefore variation was higher compared to the Canadian study.…”

Section: Discussionsupporting

confidence: 86%

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Bauer

Brueggmann

Ohlendorf

et al. 2016

BMC Health Serv Res

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BackgroundGeographical variation of the general practitioner (GP) workforce is known between rural and urban areas. However, data about the variation between and within urban areas are lacking.MethodWe analyzed distribution patterns of GP full time equivalents (FTE) in German cities with a population size of more than 500,000. We correlated their distribution with area measures of social deprivation in order to analyze preferences within neighborhood characteristics. For this purpose, we developed two area measures of deprivation: Geodemographic Index (GDI) and Cultureeconomic Index (CEI).ResultsIn total n = 9034.75 FTE were included in n = 14 cities with n = 171 districts. FTE were distributed equally on inter-city level (mean: 6.49; range: 5.12–7.20; SD: 0.51). However, on intra-city level, GP distribution was skewed (mean: 6.54; range: 1.80–43.98; SD: 3.62). Distribution patterns of FTE per 10^4 residents were significantly correlated with GDI (r = −0.49; p < 0.001) and CEI (r = −0.22; p = 0.005). Therefore, location choices of GPs were mainly positively correlated with 1) central location (r = −0.50; p < 0.001), 2) small household size of population (r = −0.50; p < 0.001) and 3) population density (r = 0.35; p < 0.001).ConclusionIntra-city distribution of GPs was skewed, which could affect the equality of access for the urban population. Furthermore, health services planners should be aware of GP location preferences. This could be helpful to better understand and plan delivery of health services. Within this process the presented Geodemographic Index (GDI) could be of use.

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Section: Discussionsupporting

confidence: 86%

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Bauer

Brueggmann

Ohlendorf

et al. 2016

BMC Health Serv Res

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“…We think probably not for the following reasons. Analyses of the same Ontario-California database observed significant primary care physician-cancer care effects that were not moderated by income in Ontario, but no such independent effects of primary care in California (Gorey et al, 2009a(Gorey et al, , 2009b. Moreover, consistent with other analysts (McGrail et al, 2009), we found that after income or insurance status are accounted for, primary care itself seems to explain very little of the health inequalities in Canada or the United States.…”

Section: Potential Study Limitationssupporting

confidence: 86%

Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

et al. 2010

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This study examined the differential effect of extreme impoverishment on breast cancer care in urban Canada and the United States. Ontario and California registry-based samples diagnosed between 1998 and 2000 were followed until 2006. Extremely poor and affluent neighborhoods were compared. Poverty was associated with non-localized disease, surgical and radiation therapy (RT) waits, nonreceipt of breast conserving surgery, RT and hormonal therapy, and shorter survival in California, but not in Ontario. Extremely poor Ontario women were consistently advantaged on care indices over their California counterparts. More inclusive health insurance coverage in Canada seems the most plausible explanation for such Canadian breast cancer care advantages.

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“…Three thousand, three hundred women diagnosed with colon cancer between 1996 and 2000 were randomly selected from the California Cancer Registry and joined to the 2000 census by census tracts [ 17 - 20 ]. The original sample was then stratified by socioeconomic status: high poverty neighborhoods where 30% or more of the households were poor, mid-poverty neighborhoods where 5% to 29% were poor or low poverty neighborhoods where the prevalence of poverty was less than 5% [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Multiplicative disadvantage of being an unmarried and inadequately insured woman living in poverty with colon cancer: historical cohort exploration in California

et al. 2015

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BackgroundMany Americans diagnosed with colon cancer do not receive indicated chemotherapy. Certain unmarried women may be particularly disadvantaged. A 3-way interaction of the multiplicative disadvantages of being an unmarried and inadequately insured woman living in poverty was explored.MethodsCalifornia registry data were analyzed for 2,319 women diagnosed with stage II to IV colon cancer between 1996 and 2000 and followed until 2014. Socioeconomic data from the 2000 census classified neighborhoods as high poverty (≥30% of households poor), middle (5–29%) or low poverty (<5% poor). Primary health insurance was private, Medicare, Medicaid or none. Comparisons of chemotherapy rates used standardized rate ratios (RR). We respectively used logistic and Cox regression models to assess chemotherapy and survival.ResultsA statistically significant 3-way marital status by health insurance by poverty interaction effect on chemotherapy receipt was observed. Chemotherapy rates did not differ between unmarried (39.0%) and married (39.7%) women who lived in lower poverty neighborhoods and were privately insured. But unmarried women (27.3%) were 26% less likely to receive chemotherapy than were married women (37.1%, RR = 0.74, 95% CI 0.58, 0.95) who lived in high poverty neighborhoods and were publicly insured or uninsured. When this interaction and the main effects of health insurance, poverty and chemotherapy were accounted for, survival did not differ by marital status.ConclusionsThe multiplicative barrier to colon cancer care that results from being inadequately insured and living in poverty is worse for unmarried than married women. Poverty is more prevalent among unmarried women and they have fewer assets so they are probably less able to absorb the indirect and direct, but uncovered, costs of colon cancer care. There seem to be structural inequities related to the institutions of marriage, work and health care that particularly disadvantage unmarried women that policy makers ought to be cognizant of as future reforms of the American health care system are considered.

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Associations of Physician Supplies with Colon Cancer Care in Ontario and California, 1996 to 2006

Abstract: 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.

Cited by 13 publications

References 39 publications

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

General practitioners in German metropolitan areas – distribution patterns and their relationship with area level measures of the socioeconomic status

Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

Multiplicative disadvantage of being an unmarried and inadequately insured woman living in poverty with colon cancer: historical cohort exploration in California

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