Rural-Urban Differences in Access to Thoracic Surgery in the United States, 2010 to 2014

Jan M Eberth; Elizabeth L Crouch; Michele J Josey; Whitney E Zahnd; Swann Arp Adams; Brendon M Stiles; Mario Schootman

doi:10.1016/j.athoracsur.2019.04.113

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Rural-Urban Differences in Access to Thoracic Surgery in the United States, 2010 to 2014

Journal article

Open access

Peer reviewed

Rural-Urban Differences in Access to Thoracic Surgery in the United States, 2010 to 2014

Jan M Eberth, Elizabeth L Crouch, Michele J Josey, Whitney E Zahnd, Swann Arp Adams, Brendon M Stiles and Mario Schootman

The Annals of thoracic surgery, Vol.108(4), pp.1087-1093

10/2019

DOI: 10.1016/j.athoracsur.2019.04.113

PMID: 31238030

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https://doi.org/10.1016/j.athoracsur.2019.04.113View

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Abstract

Because of recent lung cancer screening recommendations and corresponding insurance coverage, it is expected that more early stage cases will be identified that require thoracic surgery. However, these services may not be equally available in all regions. Our objective is to describe the availability of thoracic surgeons by examining geographic variation, rural-urban differences, and temporal changes before and after screening recommendation and insurance coverage policy changes. We examined the U.S. thoracic surgery workforce using the 2010 and 2014 Area Health Resource Files. We calculated the density of thoracic surgeons per 100,000 persons for each year at the state and county level. We performed descriptive statistics and developed maps highlighting changes over time and geographic regions. Despite an overall increase in thoracic surgeons from 2010 to 2014, we observed declining density nationwide (1.5% change) and in sparsely populated states. The difference in thoracic surgeon density widened slightly between 2010 from 0.80 per 100,000 compared with 0.84 per 100,000 in 2014 in all rural counties compared with urban counties (P < .001 for both years). The difference in thoracic surgeon density was most pronounced between small adjacent rural and urban counties (0.95 and 0.96 per 100,000 for 2010 and 2014, respectively; P < .001 for both years). The Northeast held a disproportionate share of the thoracic surgery workforce. Limited access to thoracic surgeons in rural areas is a concern, given an older and retiring surgical workforce, the higher burden of lung cancer in rural areas, and recent policy changes for screening reimbursement.

Early Detection of Cancer

Female

Health Services Accessibility - statistics & numerical data

Humans

Lung Neoplasms - diagnosis

Lung Neoplasms - epidemiology

Lung Neoplasms - surgery

Male

Morbidity - trends

Population Surveillance - methods

Retrospective Studies

Rural Population

Thoracic Surgery, Video-Assisted - statistics & numerical data

United States - epidemiology

Urban Population

Details

Title: Subtitle: Rural-Urban Differences in Access to Thoracic Surgery in the United States, 2010 to 2014
Creators: Jan M Eberth - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina. Electronic address: jmeberth@mailbox.sc.edu
Elizabeth L Crouch - Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Michele J Josey - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Whitney E Zahnd - Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Swann Arp Adams - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina
Brendon M Stiles - Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
Mario Schootman - Clinical Analytics, SSM Health, St Louis, Missouri
Resource Type: Journal article
Publication Details: The Annals of thoracic surgery, Vol.108(4), pp.1087-1093
DOI: 10.1016/j.athoracsur.2019.04.113
PMID: 31238030
ISSN: 0003-4975
eISSN: 1552-6259
Language: English
Date published: 10/2019
Academic Unit: Health Management and Policy
Record Identifier: 9984214848802771

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