Takayama Atsushi, Poudyal Hemant
Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima City 960-1295, Fukushima, Japan.
Population Health and Policy Research Unit, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Kyoto, Japan.
J Clin Med. 2021 Dec 28;11(1):155. doi: 10.3390/jcm11010155.
Since the association between disparity in physician distribution and specific healthcare outcomes is poorly documented, we aimed to clarify the association between physician maldistribution and cerebrovascular disease (CeVD), a high-priority health outcome in Japan.
In this cross-sectional study, we conducted multivariable regression analysis with the Physician Uneven Distribution Index (PUDI), a recently developed and adopted policy index in Japan that uniquely incorporates the gap between medical supply and demand, as the independent variable and CeVD death rate as the dependent variable. Population density, mean annual income, and prevalence of hypertension were used as covariates.
The coefficient of the PUDI for the CeVD death rate was -0.34 (95%CI: -0.49--0.19) before adjusting for covariates and was -0.19 (95%CI: -0.30--0.07) after adjusting. The adjusted R squared of the analysis for the PUDI was 0.71 in the final model. However, the same multivariable regression model showed that the number of physicians per 100,000 people (NPPP) was not associated with the CeVD death rates before or after adjusting for the covariates.
Incorporating the gap between the medical supply and demand in physician maldistribution indices could improve the responsiveness of the index for assessing the disparity in healthcare outcomes.
由于医生分布不均与特定医疗保健结果之间的关联记录较少，我们旨在阐明医生分布不均与脑血管疾病（CeVD）之间的关联，CeVD是日本一项高度优先的健康结果。
在这项横断面研究中，我们进行了多变量回归分析，将医生分布不均指数（PUDI）作为自变量，CeVD死亡率作为因变量。PUDI是日本最近制定并采用的一项政策指数，它独特地纳入了医疗供需之间的差距。人口密度、年均收入和高血压患病率用作协变量。
在调整协变量之前，CeVD死亡率的PUDI系数为-0.34（95%置信区间：-0.49--0.19），调整后为-0.19（95%置信区间：-0.30--0.07）。在最终模型中，PUDI分析的调整后R平方为0.71。然而，相同的多变量回归模型显示，每10万人的医生数量（NPPP）在调整协变量之前或之后与CeVD死亡率均无关联。
在医生分布不均指数中纳入医疗供需之间的差距，可以提高该指数对评估医疗保健结果差异的响应能力。
