title: Racial clustering and access to colorectal surgeons, gastroenterologists, and radiation oncologists by African Americans and Asian Americans in the United States: a county-level data analysis.
abstract: BACKGROUND
  Minority groups have poor access to quality health care services. This is true of colorectal cancer care and may be related to both geographical proximity and use of surgical, gastroenterology, and radiation oncology services. Without suitable access, many minority patients may present with advanced colorectal cancer and be less likely to receive appropriate adjuvant therapies. We sought to examine the variations in geographical access among minorities at a county level.
  
  
  METHODS
  A retrospective analysis was performed using data from the Area Resource File. Multivariate linear regression analysis was performed to identify the variations in access to colorectal surgeons, gastroenterologists, and radiation oncologists.
  
  
  METHODS
  All counties in the United States.
  
  
  METHODS
  Prevalence rate of African Americans and Asian Americans within a county.
  
  
  METHODS
  Rate of colorectal surgeons, gastroenterologists, and radiation oncologists.
  
  
  RESULTS
  Unadjusted analysis revealed that each percentage point increase in the African American population within a county was associated with a decrease in the number of specialists within that county. Multivariate analysis also revealed a statistically significant decrease in the number of gastroenterologists (P < .001) and radiation oncologists (P < .001) with each percentage point increase in the African American population and a trend toward a decrease in colorectal surgeons within that county (P = .28). Each percentage point increase in the Asian American population was associated with a significant increase in the number of gastroenterologists (P < .001) and radiation oncologists (P < .001) with a similar trend toward an increase in the number of colorectal surgeons within that county (P = .13).
  
  
  CONCLUSIONS
  Increasing numbers of minority patients in counties is accompanied by a differential access to specialists. This may affect the likelihood of a patient to receive appropriate care.
authors.affiliation: Department of General Surgery, University of Michigan Medical Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA. jhayanga@med.umich.edu
authors.forename: Awori J
authors.initials: AJ
authors.lastname: Hayanga
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.forename: Heather E
authors.initials: HE
authors.lastname: Kaiser
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Arden M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D016000:Cluster Analysis; D015179:Colorectal Neoplasms / Q000628:therapy*; D003107:Colorectal Surgery; D005006:Ethnicity / Q000706:statistics & numerical data*; D005762:Gastroenterology; D005843:Geography / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D054624:Health Status Disparities; D006801:Humans; D018787:Radiation Oncology; D014481:United States / Q000453:epidemiology; D000078329:Workforce