Access to colorectal cancer screening and treatment: Rural-urban disparity in availability of gastroenterologists, surgeons, and oncologists.

Abstract

e17534 Background: Although early detection of colorectal cancer using colonoscopy and its treatment can improve outcomes, geographic proximity may influence access to these services. We sought to examine disparities that may exist in colon cancer screening and treatment by comparing the distribution of providers for these services in rural and urban counties in the United States (US). Methods: A retrospective analysis was performed using the Health Resources and Services Administration’s Area Resource File 2009 data. Counties in the US were categorized into “rural” or “urban” using rural-urban continuum codes. The proportion of gastroenterologists, general surgeons and radiation oncologists per 100,000 people in a county was estimated. Multivariate linear regression analysis adjusting for socioeconomic variables was used to estimate the differences in proportions of gastroenterologists, general surgeons and radiation oncologists within these geographic areas. Results: A total of 3220 counties were identified comprising 1,807 “rural” and 1,413 “urban” counties. An unadjusted analysis showed an increased number of gastroenterologists, general surgeons and radiation oncologists per 100,000 of the population in urban counties as compared to rural counties. A multivariable analysis revealed 1.55 [95%CI (1.33-1.77), P<0.0001] more GI specialists, 2.03 [95% CI (1.31-2.76), p<0.0001] more general surgeons and 0.69 [95%CI (0.6-0.78), p<0.0001] more radiation oncologists per 100,000 people living in “urban” compared to “rural “counties. Conclusions: A rural-urban disparity exists in the density of gastroenterologists, general surgeons and radiation oncologists who traditionally provide colorectal cancer screening services or treatment. This might serve to affect access to these services and negatively influence outcomes for colorectal cancer in rural areas.