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Associations of Physician Supplies with Colon Cancer Care in Ontario and California, 1996 to 2006

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Abstract

Background

This study examined the differential effects of physician supplies on colon cancer care in Ontario and California. The associations of physician supplies with colon cancer stage at diagnosis, receipt of surgery and adjuvant chemotherapy, and 5-year survival were observed within each country and compared between-country.

Methods

Random samples of Ontario and California cancer registries provided 2,461 and 2,200 colon cancer cases that were diagnosed between 1996 and 2000, and followed until 2006. Both registries included data on the stage of disease at the time of diagnosis, receipt of cancer-directed surgery, receipt of adjuvant chemotherapy, and survival. Census tract-level data on low-income prevalence were, respectively, taken from 2001 and 2000 Canadian and United States population censuses. County-level primary care physician and gastroenterologist densities were computed for the same years.

Results

Significant income-adjusted, gastroenterologist density threshold effects (2.0 or more vs. less than 2.0 per 100,000 inhabitants) were observed for early diagnosis (OR = 1.57) and 5-year survival (OR = 1.63) in Ontario, but not in California. Significant incremental threshold effects of primary care physician densities on chemotherapy receipt (8.0 and 9.0 or more per 10,000 inhabitants, respective ORs of 1.79 and 2.37) were also only observed in Ontario.

Conclusions

These colon cancer care findings support the theory that while personal economic resources are more predictive in America, community-level resources such as physician supplies are more predictive of health care access and effectiveness in Canada.

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Acknowledgments

This study was supported with funds from the Canadian Breast Cancer Research Alliance (Canadian Institutes of Health Research [CIHR] grant 67161), the Canadian Cancer Society (National Cancer Institute of Canada grant 016160), the Social Sciences and Humanities Research Council of Canada (grant 410-2002-0173). KMG was also supported by an Assumption University research chair and a CIHR investigator award. The authors gratefully acknowledge the administrative and logistical assistance of Dr. William E. Wright, chief, Cancer Surveillance Section of the California Department of Health Services at the time this study was initiated. Research and technical assistance was provided by John David Stanway (Canadian Institute for Health Information), Carole Herbert (Cancer Care Ontario), Leah Archambault, Natalie Herbert, Dylan Herbert, Nancy Richter (University of Windsor) and Mark Allen (California Cancer Registry). Parts of this study were based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not those of the Canadian Institute for Health Information.

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Authors and Affiliations

  1. School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada

    Kevin M. Gorey

  2. Department of Geography, University of Western Ontario, London, ON, Canada

    Isaac N. Luginaah

  3. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada

    Emma Bartfay

  4. Department of Mathematics and Statistics, University of Windsor, Windsor, ON, Canada

    Karen Y. Fung & Madhan K. Balagurusamy

  5. Population Studies and Surveillance, Cancer Care Ontario, Toronto, ON, Canada

    Eric J. Holowaty

  6. Department of Surgery and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Frances C. Wright

  7. Clinical Trials and Research, Windsor Regional Cancer Center, Windsor, ON, Canada

    Caroline Hamm

  8. Medical Oncology Department, Windsor Regional Cancer Center, Windsor, ON, Canada

    Sindu M. Kanjeekal

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  1. Kevin M. Gorey
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Correspondence to Kevin M. Gorey.

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Gorey, K.M., Luginaah, I.N., Bartfay, E. et al. Associations of Physician Supplies with Colon Cancer Care in Ontario and California, 1996 to 2006. Dig Dis Sci 56, 523–531 (2011). https://doi.org/10.1007/s10620-010-1284-4

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  • DOI: https://doi.org/10.1007/s10620-010-1284-4

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