Frye Thomas P, Sadowski Daniel J, Zahnd Whitney E, Jenkins Wiley D, Dynda Danuta I, Mueller Georgia S, Alanee Shaheen R, McVary Kevin T
Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
J Urol. 2015 May;193(5):1608-13. doi: 10.1016/j.juro.2014.11.100. Epub 2014 Dec 10.
The urology work force is contracting at a time when service demand is increasing due to demographic changes, especially in rural areas. We investigated the impact of rural status and urologist density on kidney and renal pelvis, bladder and prostate cancer mortality at the county level in Illinois.
We stratified the 102 Illinois counties by 2003 RUCCs as urban (36, RUCCs 1 to 3) and rural (66, RUCCs 4 to 9). Area Health Resource Files were used for county demographic data and urologist density. County level age adjusted mortality rates from 1990 to 2010 were derived from National Center for Health Statistics data using SEER*Stat. We examined the associations of urological cancer mortality rates with rural status and urologist density.
Average urologist density significantly differed between rural and urban counties (1.9 vs 3.4/100,000 population, p < 0.01). The kidney and renal pelvis cancer mortality rate in rural counties was higher than in urban counties while that of prostate cancer was lower (4.9 vs 4.3 and 28.7 vs 32.2/100,000 population, respectively, each p < 0.01). Urologist density correlated with the mortality rate of kidney and renal pelvis cancer (Pearson coefficient -0.33, p < 0.01) but not with the bladder or prostate cancer mortality rate. Multiple regression analysis revealed that rurality and lower urologist density (p = 0.01 and < 0.05) were significantly associated with higher kidney and renal pelvis cancer mortality.
Rural residence and low urologist density were associated with increased kidney and renal pelvis cancer mortality on the county level in Illinois. Further expansion and testing of evidence-based telemedicine is warranted because remote technical consultation is now technologically feasible, effective, inexpensive and satisfactory to patients.
由于人口结构变化，尤其是在农村地区，泌尿外科医疗人力在服务需求增加之际却在缩减。我们调查了农村地区状况和泌尿科医生密度对伊利诺伊州县级肾及肾盂、膀胱和前列腺癌死亡率的影响。
我们根据2003年农村城市通勤区代码（RUCCs）将伊利诺伊州的102个县分为城市（36个，RUCCs 1至3）和农村（66个，RUCCs 4至9）两类。利用地区卫生资源档案获取县级人口数据和泌尿科医生密度。1990年至2010年的县级年龄调整死亡率来自美国国家卫生统计中心的数据，使用SEER*Stat软件得出。我们研究了泌尿系统癌症死亡率与农村地区状况和泌尿科医生密度之间的关联。
农村和城市县的泌尿科医生平均密度存在显著差异（分别为每10万人口1.9名和3.4名，p < 0.01）。农村县的肾及肾盂癌死亡率高于城市县，而前列腺癌死亡率则较低（分别为每10万人口4.9例对4.3例以及28.7例对32.2例，各p < 0.01）。泌尿科医生密度与肾及肾盂癌死亡率相关（皮尔逊系数为 -0.33，p < 0.01），但与膀胱癌或前列腺癌死亡率无关。多元回归分析显示，农村地区和较低的泌尿科医生密度（p = 0.01和< 0.05）与肾及肾盂癌死亡率较高显著相关。
在伊利诺伊州县级层面，农村居住和低泌尿科医生密度与肾及肾盂癌死亡率增加相关。鉴于远程技术咨询目前在技术上可行、有效、成本低廉且患者满意度高，有必要进一步扩展和测试循证远程医疗。
