Goodnight Bradley L, Hanna Glenn J, Zheng Dandan, Habila Magdiel, Cassese Marie, Fortman Alexander, Walbert Harold, Sieling Fred, Black Christopher M
Health Data Science, Guidehouse Inc., Tysons, VA, United States.
Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, United States.
Front Oncol. 2025 Jul 31;15:1521370. doi: 10.3389/fonc.2025.1521370. eCollection 2025.
Head and neck (H&N) cancers, a diverse group of epithelial malignancies, significantly impact patients' quality of life and require complex, multidisciplinary care. Despite the need for specialized care, access to H&N cancer specialists is uneven across the United States, leading to disparities in patient outcomes and health equity. To assess geographic disparities in access to H&N cancer specialists in the U.S. and to identify factors contributing to these disparities, with the goal of informing targeted interventions and policies that promote equitable healthcare access.
This geospatial analysis utilized data from various public databases, including the National Provider Identifier Registry, American Society of Clinical Oncology, and U.S. News and World Report, to examine the distribution of H&N cancer specialists relative to incident cancer cases. The study analyzed county-level data across the United States, incorporating demographic factors such as race/ethnicity, age, education, and socioeconomic status. Travel time to the nearest H&N specialist was estimated using the Travel Time API. The analysis included 1,112 H&N specialists (453 surgical oncologists, 346 medical oncologists, and 308 radiation oncologists) identified through self-reported data and relevant fellowships. The primary outcome was the estimated travel time to the nearest H&N specialist, with secondary measures including a disparity index that combined cancer incidence, social vulnerability, and travel time to highlight regions with the greatest access disparities.
Significant regional disparities in access to H&N specialists were identified, with non-metropolitan areas and regions outside the Northeast showing notably longer travel times. Socioeconomic and demographics factors, including lower household income, lower insurance coverage, and higher median age, were associated with increased travel times. Disparity Index scores highlighted counties in the South and Western regions as having the highest access disparities.
Geographic and socioeconomic disparities in access to H&N cancer specialists contribute to health inequities in the U.S. The disparity index developed in this study provides a valuable tool for identifying high-need areas and guiding policy interventions. Addressing these disparities through targeted resource allocation, mobile clinics, and provider incentives is essential for improving access to specialized care and promoting health equity.
头颈癌是一组多样的上皮性恶性肿瘤，对患者的生活质量有重大影响，需要复杂的多学科护理。尽管需要专业护理，但在美国，获得头颈癌专科医生的机会并不均等，导致患者治疗结果和健康公平性存在差异。为了评估美国获得头颈癌专科医生的地理差异，并确定导致这些差异的因素，旨在为促进公平医疗服务的针对性干预措施和政策提供依据。
这项地理空间分析利用了来自各种公共数据库的数据，包括国家提供者识别码注册中心、美国临床肿瘤学会以及《美国新闻与世界报道》，以研究头颈癌专科医生相对于癌症发病病例的分布情况。该研究分析了美国县级数据，纳入了种族/族裔、年龄、教育程度和社会经济地位等人口统计学因素。使用旅行时间应用程序编程接口估计前往最近的头颈癌专科医生的旅行时间。该分析包括通过自我报告数据和相关奖学金确定的1112名头颈癌专科医生（453名外科肿瘤学家、346名医学肿瘤学家和308名放射肿瘤学家）。主要结果是估计前往最近的头颈癌专科医生的旅行时间，次要指标包括一个差异指数，该指数综合了癌症发病率、社会脆弱性和旅行时间，以突出显示获得医疗服务差异最大的地区。
研究发现，在获得头颈癌专科医生的机会方面存在显著的地区差异，非都市地区和东北部以外的地区旅行时间明显更长。社会经济和人口统计学因素，包括家庭收入较低、保险覆盖率较低和年龄中位数较高，与旅行时间增加有关。差异指数得分突出显示南部和西部地区的县获得医疗服务的差异最大。
获得头颈癌专科医生的地理和社会经济差异导致了美国的健康不平等。本研究中开发的差异指数为识别高需求地区和指导政策干预提供了有价值的工具。通过有针对性的资源分配、移动诊所和提供者激励措施来解决这些差异，对于改善获得专科护理的机会和促进健康公平至关重要。
