Nick Mulcahy

May 14, 2011

May 14, 2011 (Washington, DC) — Living in an area with a low physician density and having a lower income are hazards for white people with urologic cancers, according to a study presented here at the American Urological Association 2011 Annual Scientific Meeting.

Mortality rates for renal and pelvis cancers are significantly higher when there is a low density of physicians relative to the general population, according to the researchers, led by Janet Colli, MD, from Tulane University in New Orleans, Louisiana, and the University of Alabama, Birmingham.

They found that in areas of the United States with a high mortality rate for renal and pelvis cancer, there was a corresponding density of only 14 physicians per 10,000 general population. In contrast, in areas with a low mortality rate, there were 42.2 physicians.

This mortality difference is potentially the "result of decreased access to medical care and reduced testing to diagnose renal and pelvis cancers at an early stage," say Dr. Colli and colleagues.

The investigators also found a "suggestive but not significant" negative association between the prevalence of physicians and mortality rates for prostate cancer and bladder cancer.

Whereas the negative association between median family income and prostate cancer was suggestive, negative associations between median family income and bladder cancer and renal and pelvis cancers were statistically significant.

These and other results were presented at a press conference on the first day of the meeting.

The analysis employed age-adjusted annual mortality rates, from 2003 to 2007, for urologic cancers in the white population. The data came from the National Vital Statistics System of the Centers for Disease Control and Prevention, say the researchers.

The US Census Bureau was the source of data on the number of physicians (858,490), the general population (290,210,914), the percentage of people without health insurance, the percentage of people living below the poverty level, and median family income.

For the analysis, counties in the United States were classified as having high or low cancer rates. High-rate counties had the 25 highest mortality rates for the 3 urologic types of cancer. Low-rate counties came from the same states as the high-rate counties, but had the lowest rates.

More Evidence

Dr. Colli and her colleagues admit that the risks and benefits of early detection of urologic cancers, especially prostate cancer, are "controversial."

Nonetheless, they hypothesized that cancer mortality rates would be higher in counties with fewer physicians relative to the general population, "since this would decrease access to medical care and reduce screening to identify cancers at an early stage."

Sure enough, they found plenty of evidence that people who live in counties with fewer doctors fare more poorly with urologic cancers.

Specifically, in addition to their statistically significant findings about renal and pelvis cancers described above, they discovered that in counties with a high mortality rate for prostate cancer, there was a corresponding density of 11.8 physicians per 10,000 general population; in counties with a low mortality rate, there were 28.8 physicians per 10,000 general population. The difference was statistically significant.

With bladder cancer, the same phenomenon held true — a lower density of doctors corresponded to a higher rate of cancer.

In counties with a high mortality rate for bladder cancer, there was a corresponding density of only 17.1 physicians per 10,000 general population; in counties with a low mortality rate, there were 33.3 physicians per 10,000 general population. Again, the difference was statistically significant.

Between the bladder cancer groups, there was also a statistically significant difference in family income. In counties with a high mortality rate for bladder cancer, average family income was $42,664; in counties with a low mortality rate, average family income was $49,733.

The authors have disclosed no relevant financial relationships.

American Urological Association (AUA) 2011 Annual Scientific Meeting: Abstract 50. Presented May 14, 2011.

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