Does uneven geographic distribution of urologists effect bladder and prostate cancers mortality? National health insurance data in Korea from 2007–2011
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Jae Heon Kim1, Hwa Yeon Sun1, Hyun Jung Kim2, Young Myoung Ko3, Dong-Il Chun4 and Jae Young Park5
1Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
2Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
3Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
4Department of Orthopaedics, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
5Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
Jae Heon Kim, email: [email protected]
Jae Young Park, email: [email protected]
Keywords: urologist density, bladder cancer, prostate cancer, mortality
Received: March 08, 2017 Accepted: May 08, 2017 Published: May 20, 2017
The relationship between distribution of urologists and mortality of bladder and prostate cancers has not been clearly established. The aim of this study was to investigate the relationship between uneven distribution of urologists and urologic cancer specific mortality at country level. Data from the National Health Insurance Service and National Statistical Office in Korea from 2007 to 2011 were analyzed in this ecological study. Univariate and multivariable regression analyses were performed to determine risk factors for age standardized mortality rates (ASMR) of bladder and prostate cancers. Linear regression analysis showed a markedly (p < 0.001) uneven distribution of urologists between metropolitan and non-metropolitan areas. There was no significant difference in cancer specific ASMRs for either bladder cancer or prostate cancer. Univariate analysis after adjusting for time showed that country area, urologist density, and income were significant factors affecting bladder cancer incidence (p < 0.001, p = 0.013, and p < 0.001, respectively). It also showed that the number of training hospitals was a significant factor for prostate cancer incidence (p = 0.002). Although country area showed borderline significance (p = 0.056) for ASMR of bladder cancer, urologist density was not related to ASMR of bladder cancer or prostate cancer. Although there was a marked difference in urologist density between metropolitan and non-metropolitan areas for these years analyzed, mortality rates of bladder and prostate cancers were not significantly affected by country area or urologist density.
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