Desjardins Michael R, Desravines Nerlyne, Fader Amanda N, Wethington Stephanie L, Curriero Frank C
Obstet Gynecol. 2023 Sep 1;142(3):688-697. doi: 10.1097/AOG.0000000000005284. Epub 2023 Aug 3.
To use a spatial modeling approach to capture potential disparities of gynecologic oncologist accessibility in the United States at the county level between 2001 and 2020.
Physician registries identified the 2001-2020 gynecologic oncology workforce and were aggregated to each county. The at-risk cohort (women aged 18 years or older) was stratified by race and ethnicity and rurality demographics. We computed the distance from at-risk women to physicians. Relative access scores were computed by a spatial model for each contiguous county. Access scores were compared across urban or rural status and racial and ethnic groups.
Between 2001 and 2020, the gynecologic oncologist workforce increased. By 2020, there were 1,178 active physicians and 98.3% practiced in urban areas (37.3% of all counties). Geographic disparities were identified, with 1.09 physicians per 100,000 women in urban areas compared with 0.1 physicians per 100,000 women in rural areas. In total, 2,862 counties (57.4 million at-risk women) lacked an active physician. Additionally, there was no increase in rural physicians, with only 1.7% practicing in rural areas in 2016-2020 relative to 2.2% in 2001-2005 ( P =.35). Women in racial and ethnic minority populations, such as American Indian or Alaska Native and Hispanic women, exhibited the lowest level of access to physicians across all time periods. For example, 23.7% of American Indian or Alaska Native women did not have access to a physician within 100 miles between 2016 and 2020, which did not improve over time. Non-Hispanic Black women experienced an increase in relative accessibility, with a 26.2% increase by 2016-2020. However, Asian or Pacific Islander women exhibited significantly better access than non-Hispanic White, non-Hispanic Black, Hispanic, and American Indian or Alaska Native women across all time periods.
Although the U.S. gynecologic oncologist workforce increased steadily over 20 years, this has not translated into evidence of improved access for many women from rural and underrepresented areas. However, health care utilization and cancer outcomes may not be influenced only by distance and availability. Policies and pipeline programs are needed to address these inequities in gynecologic cancer care.
采用空间建模方法，了解2001年至2020年美国县级妇科肿瘤医生可及性的潜在差异。
通过医生登记系统确定2001 - 2020年的妇科肿瘤医生队伍，并汇总至各县。高危人群（18岁及以上女性）按种族、民族和农村人口统计学特征进行分层。我们计算了高危女性到医生的距离。通过空间模型为每个相邻县计算相对可及性得分。比较城市或农村地区以及不同种族和民族群体的可及性得分。
2001年至2020年期间，妇科肿瘤医生队伍有所增加。到2020年，有1178名在职医生，98.3%在城市地区执业（占所有县的37.3%）。发现了地理差异，城市地区每10万名女性中有1.09名医生，而农村地区每10万名女性中只有0.1名医生。总共有2862个县（5740万高危女性）没有在职医生。此外，农村医生数量没有增加，2016 - 2020年期间只有1.7%的医生在农村地区执业，而2001 - 2005年为2.2%（P = 0.35）。在所有时间段内，美国印第安人或阿拉斯加原住民以及西班牙裔等少数族裔女性获得医生服务的水平最低。例如，2016年至2020年期间，23.7%的美国印第安人或阿拉斯加原住民女性在100英里范围内无法获得医生服务，且这一情况并未随时间改善。非西班牙裔黑人女性的相对可及性有所增加，到2016 - 2020年增加了26.2%。然而，在所有时间段内，亚裔或太平洋岛民女性获得医生服务的情况明显优于非西班牙裔白人、非西班牙裔黑人、西班牙裔以及美国印第安人或阿拉斯加原住民女性。
尽管美国妇科肿瘤医生队伍在20年里稳步增加，但这并未转化为许多农村和代表性不足地区女性获得更好医疗服务的证据。然而，医疗保健利用和癌症治疗结果可能不仅受距离和可及性的影响。需要制定政策和实施相关培养计划来解决妇科癌症护理中的这些不平等问题。
