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. 2024 Jan-Dec:31:10732748241244929.
doi: 10.1177/10732748241244929.

The Association of Oncology Provider Density With Black-White Disparities in Cancer Mortality in US Counties

Yuehan Zhang  1 , Kathryn M Leifheit  2 , Kimberley T Lee  3 , Roland J Thorpe Jr  4   5 , Darrell J Gaskin  4   6 , Lorraine T Dean  1   6   7
Affiliations

The Association of Oncology Provider Density With Black-White Disparities in Cancer Mortality in US Counties

Yuehan Zhang et al. Cancer Control. 2024 Jan-Dec.

Abstract

Background: Black-White racial disparities in cancer mortality are well-documented in the US. Given the estimated shortage of oncologists over the next decade, understanding how access to oncology care might influence cancer disparities is of considerable importance. We aim to examine the association between oncology provider density in a county and Black-White cancer mortality disparities.

Methods: An ecological study of 1048 US counties was performed. Oncology provider density was estimated using the 2013 National Plan and Provider Enumeration System data. Black:White cancer mortality ratio was calculated using 2014-2018 age-standardized cancer mortality rates from State Cancer Profiles. Linear regression with covariate adjustment was constructed to assess the association of provider density with (1) Black:White cancer mortality ratio, and (2) cancer mortality rates overall, and separately among Black and White persons.

Results: The mean Black:White cancer mortality ratio was 1.12, indicating that cancer mortality rate among Black persons was on average 12% higher than that among White persons. Oncology provider density was significantly associated with greater cancer mortality disparities: every 5 additional oncology providers per 100 000 in a county was associated with a .02 increase in the Black:White cancer mortality ratio (95% CI: .007 to .03); however, the unexpected finding may be explained by further analysis showing that the relationship between oncology provider density and cancer mortality was different by race group. Every 5 additional oncologists per 100 000 was associated with a 1.6 decrease per 100 000 in cancer mortality rates among White persons (95% CI: -3.0 to -.2), whereas oncology provider density was not associated with cancer mortality among Black persons.

Conclusion: Greater oncology provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. Higher oncology provider density alone may not resolve cancer mortality disparities, thus attention to ensuring equitable care is critical.

Keywords: cancer; mortality; oncology provider density; racial disparities; workforce.

Plain language summary

Our study provides timely information to address the growing concern about the need to increase oncology supply and the impact it might have on racial disparities in cancer outcomes. This analysis of counties across the US is the first study to estimate the association of oncology provider density with Black-White racial disparities in cancer mortality. We show that having more oncology providers in a county is associated with significantly lower cancer mortality among the White population, but is not associated with cancer mortality among the Black population, thereby leading to a disparity. Our findings suggest that having more oncology providers alone may be insufficient to overcome existing disadvantages for Black patients to access and use high-quality cancer care. These findings have important implications for addressing racial disparities in cancer outcomes that are persistent and well-documented in the US.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Map of oncology provider density per 100 000 in 2013 (Panel A) and cancer mortality ratio comparing Black to White persons from 2014-2018 (Panel B) for US counties and the District of Columbia. Note. In Panel a, oncologist count data came from the 2013 CMS National Plan and Provider Enumeration System. In Panel b, Black-White cancer mortality ratio was defined as age-standardized cancer mortality rate among Black persons of a given county divided by the rate among White persons. Cancer mortality rates included all cancer sites, all ages and sexes, from 2014 to 2018, provided by the State Cancer Profiles. Greater inequity in cancer mortality rate was depicted by red color (higher cancer mortality rate for Black vs White persons) or blue color (lower cancer mortality rate for Black vs White persons). Equity in cancer mortality rate was depicted by white color. (A) total of 1075 counties had complete data for cancer mortality ratio. Cancer mortality ratio was unavailable for 2067 counties, depicted by grey color, where race-specific cancer mortality rates were unavailable on the State Cancer Profiles. R (version 4.0.2) was used to generate the figure.
Figure 2.
Figure 2.
Association of oncology provider density (per 100 000) with age-standardized cancer mortality rates (per 100 000) overall and among Black and White persons in the US. Note. Estimate represents the change in age-standardized cancer mortality rate per 100 000 associated with 1 standard deviation increase in oncology provider density per 100 000. Estimate was adjusted for age-standardized cancer incidence rate per 100 000 (overall and among Black and White persons, respectively), Gini index, percent of population that is Black (only in the model of overall cancer mortality rates), percent of health insurance coverage, metropolitan status, and census region. Error bars indicate 95% confidence interval (CI). R (version 4.0.2) was used to generate the figure.
Figure 3.
Figure 3.
Predicted cancer mortality rates per 100 000 among Black and White persons by oncology provider density in the US. Note. Predicted cancer mortality rates were estimated after fitting a multivariable linear regression model for the outcome of cancer mortality rates among Black and White persons separately, adjusting for Gini index, cancer incidence rate (among Black and White persons, respectively), percent of health insurance coverage, metropolitan status, and census region. Error bar indicates 95% confidence interval for the predicted estimates. Excel was used to generate the figure.
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References

    1. Cancer Facts & Figures for African Americans . American cancer society. https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-fig.... Accessed July 18, 2024.
    1. O’Keefe EB, Meltzer JP, Bethea TN. Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Front Public Health. 2015;3. doi:10.3389/fpubh.2015.00051. - DOI - PMC - PubMed
    1. Ahmed AT, Welch BT, Brinjikji W, et al. Racial disparities in screening mammography in the United States: a systematic review and meta-analysis. J Am Coll Radiol. 2017;14(2):157-165.e9. doi:10.1016/j.jacr.2016.07.034. - DOI - PubMed
    1. Grubbs SS, Polite BN, Carney J, et al. Eliminating racial disparities in colorectal cancer in the real world: it took a village. J Clin Oncol. 2013;31(16):1928-1930. doi:10.1200/JCO.2012.47.8412. - DOI - PMC - PubMed
    1. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211-233. doi:10.3322/caac.21555. - DOI - PubMed

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