title: Geographic analysis of urologist density and prostate cancer mortality in the United States.
abstract: BACKGROUND
  Financial and demographic pressures in US require an understanding of the most efficient distribution of physicians to maximize population-level health benefits. Prior work has assumed a constant negative relationship between physician supply and mortality outcomes throughout the US and has not addressed regional variation.
  
  
  METHODS
  In this ecological analysis, geographically weighted regression was used to identify spatially varying relationships between local urologist density and prostate cancer mortality at the county level. Data from 1,492 counties in 30 eastern and southern states from 2006-2010 were analyzed.
  
  
  RESULTS
  The ordinary least squares (OLS) regression found that, on average, increasing urologist density by 1 urologist per 100,000 people resulted in an expected decrease in prostate cancer mortality of -0.499 deaths per 100,000 men (95% CI -0.709 to -0.289, p-value < 0.001), or a 1.5% decrease. Geographic weighted regression demonstrated that the addition of one urologist per 100,000 people in counties in the southern Mississippi River states of Arkansas, Mississippi, and Louisiana, as well as parts of Illinois, Indiana, and Wisconsin is associated with decrease of 0.411 to 0.916 in prostate cancer mortality per 100,000 men (1.6-3.6%). In contrast, the urologist density was not significantly associated with the prostate state mortality in the new England region.
  
  
  CONCLUSIONS
  The strength of association between urologist density and prostate cancer mortality varied regionally. Those areas with the highest potential for effects could be targeted for increasing the supply of urologists, as it associated with the largest predicted improvement in prostate cancer mortality.
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, VA, United States of America.
authors.forename: Nengliang
authors.initials: N
authors.lastname: Yao
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, VA, United States of America.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Foltz
authors.affiliation: Department of Urology, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States of America.
authors.forename: Anobel Y
authors.initials: AY
authors.lastname: Odisho
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States of America.
authors.forename: David C
authors.initials: DC
authors.lastname: Wheeler
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D003710:Demography; D005843:Geography; D006297:Health Services Accessibility; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010820:Physicians / Q000600:supply & distribution; D011471:Prostatic Neoplasms / Q000401:mortality*; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology; D014572:Urology; D000078329:Workforce