Abstract
Background: Since the association between disparity in physician distribution and specific healthcare outcomes is poorly documented, we aimed to clarify the association between physician maldistribution and cerebrovascular disease (CeVD), a high-priority health outcome in Japan. Methods: In this cross-sectional study, we conducted multivariable regression analysis with the Physician Uneven Distribution Index (PUDI), a recently developed and adopted policy index in Japan that uniquely incorporates the gap between medical supply and demand, as the independent variable and CeVD death rate as the dependent variable. Population density, mean annual income, and prevalence of hypertension were used as covariates. Results: The coefficient of the PUDI for the CeVD death rate was −0.34 (95%CI: −0.49–−0.19) before adjusting for covariates and was −0.19 (95%CI: −0.30–−0.07) after adjusting. The adjusted R squared of the analysis for the PUDI was 0.71 in the final model. However, the same multivariable regression model showed that the number of physicians per 100,000 people (NPPP) was not associated with the CeVD death rates before or after adjusting for the covariates. Conclusion: Incorporating the gap between the medical supply and demand in physician maldistribution indices could improve the responsiveness of the index for assessing the disparity in healthcare outcomes.
Highlights
Accepted: 21 December 2021The population of Japan is shrinking and aging at an unprecedented rate
To estimate the relation between the Physician Uneven Distributed Index (PUDI) and healthcare outcomes, we have investigated the association between geographical inequality in physician distribution at a prefectural level measured by the PUDI in 2018 and the cerebrovascular disease (CeVD) death rate
The geographical distribution of the PUDI and the CeVD death rate among the 47 prefectures of Japan shows that Northern Honshu has a low PUDI and high CeVD
Summary
Accepted: 21 December 2021The population of Japan is shrinking and aging at an unprecedented rate. Despite the declining death rates, mitigating the risk factors of CeVD is one of the top priorities of primary care physicians in Japan [7,8] for several reasons: First, the absolute number of patients with CeVD is expected to increase, and most of the CeVD disease burden in Japan is within the growing older population (> 60 years) [9]. Uneven Distribution Index (PUDI), a recently developed and adopted policy index in Japan that uniquely incorporates the gap between medical supply and demand, as the independent variable and CeVD death rate as the dependent variable. The adjusted R squared of the analysis for the PUDI was 0.71 in the final model. The same multivariable regression model showed that the number of physicians per 100,000 people (NPPP) was not associated with the CeVD death rates before or after adjusting for the covariates. Conclusion: Incorporating the gap between the medical supply and demand in physician maldistribution indices could improve the responsiveness of the index for assessing the disparity in healthcare outcomes
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