PD17-12 PRIMARY CARE PHYSICIAN DENSITY AND INSURANCE STATUS ON STAGE OF DIAGNOSIS FOR UROLOGIC MALIGNANCIES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-12 PRIMARY CARE PHYSICIAN DENSITY AND INSURANCE STATUS ON STAGE OF DIAGNOSIS FOR UROLOGIC MALIGNANCIES Kristy Nguyen, Marshall Shaw, Sarah Maness, Sanjay Patel, and Kelly Stratton Kristy NguyenKristy Nguyen More articles by this author , Marshall ShawMarshall Shaw More articles by this author , Sarah ManessSarah Maness More articles by this author , Sanjay PatelSanjay Patel More articles by this author , and Kelly StrattonKelly Stratton More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cancer stage at diagnosis is an important indicator of outcome. Previous studies have shown an inverse relationship to primary care physician (PCP) density and stage of cancer diagnosis. This study evaluated PCP density and insurance status for urologic malignancies in Oklahoma to test the hypothesis that increased PCP density would still be associated with lower stage disease even in a state with a generally low PCP density. METHODS OK2Share, the Oklahoma State Department of Health database, was accessed for Prostate, Kidney, and Bladder cancer diagnoses from 2000-2010. Each was stratified by county, insurance type, and stage at diagnosis. Advanced stage was defined as the presence of regional or distant disease; in-situ results were not included. Age was restricted to 20-85+ years old. The number of PCPs was determined by using the Oklahoma State Licensing Board for active internal medicine and family medicine physicians by counties. Population data was obtained through the 2010 national census. High PCP density was defined as anything greater than or equal to the median value: 3.17 PCP/10,000. RESULTS 34,783 patients were identified across 77 counties of which 36 were considered high PCP density. Logarithmic regression showed that as the PCP density increases by 1 PCP/10,000, the odds ratios (OR) of having an advanced stage at diagnosis were 0.383, 0.468, 0.543 for bladder, kidney, and prostate cancer respectively. In high PCP density areas, Medicare coverage reduced the likelihood of having advanced bladder or prostate cancer (OR: 0.67 and 0.68 respectively) but increased the likelihood of advanced kidney cancer (OR: 1.46) compared to private insurance. Being uninsured had a higher likelihood of advanced kidney and prostate cancers (OR: 1.61 and 2.45 respectively) compared to having private insurance. CONCLUSIONS This study confirms previous studies finding increases in PCP density reduced the odds of advanced cancer stage at diagnosis. Insured patients also had reduced odds of advanced stage at diagnosis. Implementation of policies to improve access to healthcare, through increasing PCP density and insuring patients may result in improved cancer-related outcomes through diagnosis at earlier cancer stage. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e403 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Kristy Nguyen More articles by this author Marshall Shaw More articles by this author Sarah Maness More articles by this author Sanjay Patel More articles by this author Kelly Stratton More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...