Association of county-level provider density and social vulnerability with colorectal cancer-related mortality

Muhammad Muntazir Mehdi Khan; Muhammad Musaab Munir; Mujtaba Khalil; Diamantis I Tsilimigras; Selamawit Woldesenbet; Yutaka Endo; Erryk Katayama; Zayed Rashid; Lisa Cunningham; Matthew Kaladay; Timothy M Pawlik

doi:10.1016/j.surg.2024.03.035

Association of county-level provider density and social vulnerability with colorectal cancer-related mortality

Surgery. 2024 May 10:S0039-6060(24)00200-9. doi: 10.1016/j.surg.2024.03.035. Online ahead of print.

Affiliations

¹ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
² Department of Surgery, Division of Colorectal Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
³ Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH. Electronic address: Tim.Pawlik@osumc.edu.

PMID: 38729889
DOI: 10.1016/j.surg.2024.03.035

Abstract

Background: Health care providers play a crucial role in increasing overall awareness, screening, and treatment of cancer, leading to reduced cancer mortality. We sought to characterize the impact of provider density on colorectal cancer population-level mortality.

Methods: County-level provider data, obtained from the Area Health Resource File between 2016 and 2018, were used to calculate provider density per county. These data were merged with county-level colorectal cancer mortality 2016-2020 data from the Centers for Disease Control and Prevention. Multivariable regression was performed to define the association between provider density and colorectal cancer mortality.

Results: Among 2,863 counties included in the analytic cohort, 1,132 (39.5%) and 1,731 (60.5%) counties were categorized as urban and rural, respectively. The colorectal cancer-related crude mortality rate was higher in counties with low provider density versus counties with moderate or high provider density (low = 22.9, moderate = 21.6, high = 19.3 per 100,000 individuals; P < .001). On multivariable analysis, the odds of colorectal cancer mortality were lower in counties with moderate and high provider density versus counties with low provider density (moderate odds ratio 0.97, 95% confidence interval 0.94-0.99; high odds ratio 0.88, 95% confidence interval 0.86-0.91). High provider density remained associated with a lower likelihood of colorectal cancer mortality independent of social vulnerability index (low social vulnerability index and high provider density: odds ratio 0.85, 95% confidence interval 0.81-0.89; high social vulnerability index and high provider density: odds ratio 0.93, 95% confidence interval 0.89-0.98).

Conclusion: Regardless of social vulnerability index, high county-level provider density was associated with lower colorectal cancer-related mortality. Efforts to increase access to health care providers may improve health care equity, as well as long-term cancer outcomes.