PHS113 - Geographic Variation in Utilization of Physician Services Among Older Adults Diagnosed with Non-Hodgkin Lymphoma

Abstract

Geographic characteristics such as county-level socioeconomic status (SES) or accessibility of health services may play a role in behavioral decisions to visit a physician following a diagnosis of Non-Hodgkin Lymphoma (NHL). There is limited research to identify which geographic characteristics factor into the behavioral decisions. We analyzed linked registry and Medicare claims data for individuals diagnosed with NHL between 2000 and 2013. Outcome measures were the proportion and counts of: 1) all outpatient physician (OP) visits; 2) medical oncologist (MO) visits. The primary predictors were county-level SES and health services supply factors (HSSF). We utilized hierarchical generalized linear models (HGLM) with an offset for differential follow-up. We reported intraclass correlation coefficients (ICC) for the binary models. For both binary and count models, we reported median odds ratios (MORs) for the county-level random effect and interval odds ratios (IORs) for the county-level fixed effects. The sample included 72,973 individuals living in 590 counties. The average age was 78 years and the sample was 87% White, non-Hispanic. The median number of OP visits and MO visits per person was 19 and 14, respectively, over a median follow-up of 883 days. For the OP logistic HGLM: 1) the ICC was 3%; 2) the MOR was 1.3; 3) the IORs were [0.65; 1.21] for the SES index and [1.04; 1.93] for the HSSF index. For the MO logistic HGLM: 1) the ICC was 8%; 2) the MOR was 1.6; 3) the IORs were [0.4; 2.5] for the SES index and [0.35; 2.21] for the HSSF index. There was a larger role for county-level HSSF compared to the county-level SES in the HGLM count models. Among individuals diagnosed with NHL, there is a larger role for the county-level measure of health services accessibility compared to the county-level measure of socioeconomic status.