Physician Supply and Breast Cancer Survival

Kevin M. Gorey; Isaac N. Luginaah; Karen Y. Fung; Emma Bartfay; Caroline Hamm; Frances C. Wright; Madhan Balagurusamy; Eric J. Holowaty

doi:10.3122/jabfm.2010.01.090064

Article Figures & Data

Tables

View popup

Table 1.

Associations of General Practitioner Supplies with Breast Cancer 5-Year Survival among Women in Ontario Diagnosed Between 1995 and 1997 and Followed Until January 1, 2003

General Practitioner Supply Predictor	Risk Factor	Prevalence (%)	Breast Cancer5-Year Survival(odds ratio [95% CI])
Provincial analysis of 17,829 breast cancer cases
≥7 per 10,000 in 2001	<7	66.2	1.09 (0.98, 1.21)^*
≥7.25 per 10,000 in 2001	<7.25	68.1	1.14 (1.01, 1.29)
Analysis of 10,745 cases outside the greater metropolitan Toronto area
Decreased by ≥3 per 10,000 in 1991 and 2001^†		16.5^‡	0.83 (0.68, 1.03)^§

All effects were adjusted for patient age, census tract low-income prevalence, census division age distribution, distance from regional cancer centers, and obstetrician/gynecologist supplies. Total physician density did not enter the model. There were 10,291 and 10,122 active general practitioners in Ontario in 1991 and 2001, respectively.
* 90% confidence interval did not include the null (1.00–1.19; P < .10).
† Sensitivity analyses revealed the most predictive criterion decrement.
‡ Overrepresented by small to mid-sized cities with populations between 100,000 and 500,000.
§ 90% CI did not include the null (0.70–0.99; P < .10).

View popup

Table 2.

Associations of Obstetrics/Gynecology Specialist Supplies with Breast Cancer 5-Year Survival in Ontario: Women Diagnosed Between 1995 and 1997 Were Followed Until January 1, 2003

Obstetrician/Gynecologist Supply Predictor	Risk Factor	Prevalence (%)	Breast Cancer5-Year Survival(OR [95% CI])
Provincial analysis of 17,829 breast cancer cases
≥6 per 100,000 in 2001	<6	59.7	1.13 (1.01–1.27)
Analysis of 10,745 cases outside the greater metropolitan Toronto area
Decreased by ≥2 per 100,000 in 1991 and 2001^*		20.2^†	0.76 (0.61–0.96)

All effects were adjusted for patient age, census tract low-income prevalence, census division age distribution, distance from regional cancer centers, and general practitioner supplies. Total physician density did not enter the model. There were 648 and 664 active obstetrician/gynecologists in Ontario in 1991 and 2001, respectively.
* Sensitivity analyses revealed the most predictive criterion decrement.
† Overrepresented by small to mid-sized cities with populations between 100,000 and 500,000.