title: The Effect of Gynecologic Oncologist Availability on Ovarian Cancer Mortality.
abstract: OBJECTIVE
  To determine the association between the distribution of gynecologic oncologist (GO) and population-based ovarian cancer death rates.
  
  
  METHODS
  Data on ovarian cancer incidence and mortality in the United States (U.S.) was supplemented with U.S. census data, and analyzed in relation to practicing GOs. GO locations were geocoded to link association between county variables and GO availability. Logistic regression was used to measure areas of high and low ovarian cancer mortality, adjusting for contextual variables.
  
  
  RESULTS
  Practicing GOs were unevenly distributed in the United States, with the greatest numbers in metropolitan areas. Ovarian cancer incidence and death rates increased as distance to a practicing GO increased. A relatively small number (153) of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates. Counties located 50 or more miles away from a GO practice had an almost 60% greater odds of high ovarian cancer mortality compared to those with closer practicing GOs (OR 1.59, 95% CI 1.18-2.15).
  
  
  CONCLUSIONS
  The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality. Efforts that facilitate outreach of GOs to certain populations may increase geographic access. Future studies examining other factors associated with lack of GO access (e.g. insurance and other socioeconomic factors) at the individual level will assist with further defining barriers to quality ovarian cancer care in the United States.
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: Stewart
authors.affiliation: SciMetrika, LLC, Research Triangle Park, North Carolina, USA.
authors.forename: Darryl
authors.initials: D
authors.lastname: Cooney
authors.affiliation: SciMetrika, LLC, Research Triangle Park, North Carolina, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Hirsch
authors.affiliation: SciMetrika, LLC, Research Triangle Park, North Carolina, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Westervelt
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Richards
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Sun Hee
authors.initials: SH
authors.lastname: Rim
authors.affiliation: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
authors.forename: Cheryll C
authors.initials: CC
authors.lastname: Thomas
keywords: access to care; gynecologic oncologists; mortality; ovarian cancer