Department of Health Care Management, Berlin University of Technology, Strasse des 17 Juni 135, Berlin, Germany.
Health Policy. 2011 Nov;103(1):53-62. doi: 10.1016/j.healthpol.2011.08.004. Epub 2011 Oct 2.
Measures of avoidable deaths incorporate the notion that deaths from certain causes should not occur within specified age groups given effective prevention or timely and appropriate access to health care. The present study investigated the impact on specific types of avoidable cancer deaths (ACD) of regional variations in the supply of health services over five years using German districts (Kreise und kreisfreie Städte) as units of analysis.
Age-standardized, average ACD rates were calculated for 2000-2004 for each of the 439 districts in Germany using unit-record mortality data. The distribution of ACD was subsequently analyzed using country maps and negative binomial regression with random intercepts. Potential endogeneity of physician supply to ACD was controlled for using an instrumental variable approach. The panel data for the years 2000-2004 were merged from a range of official statistics including mortality and hospital records (DESTATIS) and statistics provided by the Federal Office for Building and Regional Planning (INKAR).
In women, 27.81 per 100,000 died from preventable or treatable cancer types in an average year between 2000 and 2004. The rates for men were generally higher, with 40.07 standardized ACD per 100,000. The regression results showed that an increase in physician supply per 100,000 was significantly associated with lower ACD rates in cancer of the female breast, and cancer of the colon, rectosigmoid junction, rectum and anus in both sexes. The contribution ranged from a decrease by a factor of 0.9994 (female breast cancer) to a factor of 0.9986 (cancer of the colon, rectosigmoid junction, rectum and anus in men) in ACD rate as the physician-population ratio increased by one unit.
An increase in physician density tended to be associated with a small reduction in some ACD rates. We suggest that better accessibility or quality of care might have linked increased physician density with improved health outcomes.
可避免死亡的衡量标准包含了这样一种概念，即在特定年龄组中，某些原因导致的死亡如果采取有效的预防措施或及时、适当地获得医疗保健，本不应该发生。本研究使用德国县（Kreise 和 kreisfreie Städte）作为分析单位，考察了五年间卫生服务供应的区域差异对特定类型可避免癌症死亡（ACD）的影响。
使用单位记录死亡率数据，为德国 439 个地区中的每一个计算了 2000-2004 年标准化平均 ACD 率。随后使用国家地图和带有随机截距的负二项式回归分析 ACD 的分布。使用工具变量方法控制医师供应与 ACD 的潜在内生性。2000-2004 年的面板数据由一系列官方统计数据（包括死亡率和医院记录（DESTATIS）和联邦建筑和区域规划办公室（INKAR）提供的统计数据）合并而成。
在女性中，2000 年至 2004 年期间，平均每年有 27.81 人死于可预防或可治疗的癌症类型。男性的比率通常较高，标准化 ACD 为每 100,000 人 40.07 人。回归结果表明，每 100,000 人增加医生供应量与女性乳腺癌和男女结肠、直肠乙状结肠交界处、直肠和肛门癌症的 ACD 率显著降低相关。当医生-人口比增加一个单位时，ACD 率的下降幅度从 0.9994（女性乳腺癌）到 0.9986（男性结肠癌、直肠乙状结肠交界处、直肠和肛门癌）不等。
医生密度的增加往往与一些 ACD 率的小幅下降有关。我们认为，更好的可及性或医疗质量可能与增加医生密度与改善健康结果有关。
