Associations of Physician Supplies with Colon Cancer Care in Ontario and California, 1996 to 2006
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Kevin M. Gorey Isaac N. Luginaah Emma Bartfay Karen Y. Fung Eric J. Holowaty Frances C. Wright Caroline Hamm Sindu M. Kanjeekal Madh
- چاپ و سال / کشور: 2010
Description
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 cancerdirected 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
Dig Dis Sci (2011) 56:523–531 DOI 10.1007/s10620-010-1284-4 Received: 2 December 2009 / Accepted: 11 May 2010 / Published online: 3 June 2010
