title: Impact of county rurality and urologist density on urological cancer mortality in illinois.
abstract: OBJECTIVE
  The urology work force is contracting at a time when service demand is increasing due to demographic changes, especially in rural areas. We investigated the impact of rural status and urologist density on kidney and renal pelvis, bladder and prostate cancer mortality at the county level in Illinois.
  
  
  METHODS
  We stratified the 102 Illinois counties by 2003 RUCCs as urban (36, RUCCs 1 to 3) and rural (66, RUCCs 4 to 9). Area Health Resource Files were used for county demographic data and urologist density. County level age adjusted mortality rates from 1990 to 2010 were derived from National Center for Health Statistics data using SEER*Stat. We examined the associations of urological cancer mortality rates with rural status and urologist density.
  
  
  RESULTS
  Average urologist density significantly differed between rural and urban counties (1.9 vs 3.4/100,000 population, p < 0.01). The kidney and renal pelvis cancer mortality rate in rural counties was higher than in urban counties while that of prostate cancer was lower (4.9 vs 4.3 and 28.7 vs 32.2/100,000 population, respectively, each p < 0.01). Urologist density correlated with the mortality rate of kidney and renal pelvis cancer (Pearson coefficient -0.33, p < 0.01) but not with the bladder or prostate cancer mortality rate. Multiple regression analysis revealed that rurality and lower urologist density (p = 0.01 and < 0.05) were significantly associated with higher kidney and renal pelvis cancer mortality.
  
  
  CONCLUSIONS
  Rural residence and low urologist density were associated with increased kidney and renal pelvis cancer mortality on the county level in Illinois. Further expansion and testing of evidence-based telemedicine is warranted because remote technical consultation is now technologically feasible, effective, inexpensive and satisfactory to patients.
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Frye
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sadowski
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Whitney E
authors.initials: WE
authors.lastname: Zahnd
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Wiley D
authors.initials: WD
authors.lastname: Jenkins
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Danuta I
authors.initials: DI
authors.lastname: Dynda
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Georgia S
authors.initials: GS
authors.lastname: Mueller
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois.
authors.forename: Shaheen R
authors.initials: SR
authors.lastname: Alanee
authors.affiliation: Division of Urology and Center for Clinical Research (WEZ, WDJ, DID, GSM), Southern Illinois University School of Medicine, Springfield, Illinois. Electronic address: kmcvary@siumed.edu.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: McVary
mesh_terms: D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality*; D008297:Male; D011471:Prostatic Neoplasms / Q000401:mortality*; D012423:Rural Health; D001749:Urinary Bladder Neoplasms / Q000401:mortality*; D014572:Urology; D000078329:Workforce
keywords: kidney neoplasms; mortality; prostatic neoplasms; rural health services; urinary bladder neoplasms