Hong Young-Rock, Mainous Arch G, Revere Lee, Mathews Simon
Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.
Cancer Control and Population Sciences Program, UF Health Cancer Center, Gainesville, Florida.
Gastro Hep Adv. 2023 Apr 15;2(6):810-817. doi: 10.1016/j.gastha.2023.04.001. eCollection 2023.
The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP).
This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation.
Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval, -11.0 to -0.1) but not with EoCRC mortality ( = .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval, -46.1 to -7.8) but not with EoCRC incidence ( = .077).
Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.
在美国年轻成年人群中，早发性结直肠癌（EoCRC）的负担一直在增加。本研究的目的是调查EoCRC的发病率和死亡率与胃肠病学（GI）专科医生和初级保健医生（PCP）供应之间的关系。
这是一项对2014年至2018年间美国各县EoCRC病例的生态学研究。数据来自美国癌症统计。县级数据，包括社会人口统计学数据（如女性、非白人居民的百分比、贫困率、农村地区情况）和医生供应情况（GI专科医生和PCP），来自区域卫生资源文件。我们估计了以县为随机效应的线性混合效应模型，以检验医生供应与5年平均年龄调整后的EoCRC发病率和死亡率之间的关联。模型针对县级总体社会经济特征进行了调整。通过方差膨胀检验多重共线性。
分析纳入了855个美国县。2014 - 2018年间，年龄调整后的EoCRC平均发病率和死亡率分别为每10万人9.5例（标准差[SD]：2.7）和2.7例（SD：0.8）。在调整后的模型中，GI专科医生供应与较低的EoCRC发病率相关（每标准差变化-5.6个百分点；95%置信区间，-11.0至-0.1），但与EoCRC死亡率无关（P = 0.558）。PCP供应与较低的EoCRC死亡率相关（每标准差变化-27.0个百分点；95%置信区间，-46.1至-7.8），但与EoCRC发病率无关（P = 0.077）。
更多的GI专科医生供应与EoCRC发病率降低相关，但与死亡率改善无关。研究结果表明需要开展早期结直肠癌筛查工作，以及在医疗服务不足地区扩大GI服务和转诊的潜力。
