Abstract 17355: Rural-Urban Differences in the Association of Change in County-Level Physician Density With Cardiovascular Disease Mortality

Abstract

Introduction: Rural areas face greater challenges in access to cardiovascular care related to lower physician density compared with urban areas. However, whether the association between recent changes in primary care physicians (PCP) and cardiologist density and contemporary CVD mortality differs by county-level urbanization is unknown. Hypothesis: Decreases in county-level physician density per capita between 2011-2017 will be associated with higher CVD mortality in rural compared with urban counties in 2017-18 in the US. Methods: Death certificates from CDC WONDER with CVD (ICD-10 codes I00-09, I11, I13, I20-51) listed as the underlying cause of death between 2017-2018 were queried to calculate age-adjusted mortality rate (AAMR) at the county-level. Changes in county-level PCPs (2011-2017) and cardiologists (2011-2017) per 100,000 population were derived from the Area Health Resources Files. We performed univariable and multivariable linear regression to determine the association between change in physician density and county-level CVD AAMR adjusted for county-level demographic and socioeconomic characteristics and baseline physician density. Results: PCP and cardiologist density was lower in rural counties compared with urban counties (Table). Between 2011 and 2017, PCP density decreased in rural (-2.2 [SD 15.8]) and increased in urban counties (0.8 [9.1]). Conversely, cardiologist density increased in rural (0.1 [1.8]) and decreased in urban counties (-0.1 [2.1]). Increases in PCP density were associated with lower CVD AAMR in both rural and urban counties (p<0.01). However, changes cardiologist density were not associated with lower CVD AAMR in multivariable analyses. Conclusion: Cardiologist density in rural counties was less than one-third that of urban counties and was not associated with CVD mortality. Increases in PCP density between 2011-17 was significantly associated with lower CVD AAMR in 2017-18 in both rural and urban counties.