Effect of gynecologic oncologist availability on ovarian cancer mortality

Table 1 United States county characteristics by distance to gynecologic oncologist practice location

	Distance to closest gynecologic oncologist
	0 to <25 miles	>25 to < 50 miles	> 50 miles
No. of US counties	536	890	1683
County designation	n (%)	n (%)	n (%)
Metropolitan	486 (90.7)	345 (38.8)	255 (15.2)
Non-metropolitan	42 (7.8)	424 (47.6)	901 (53.5)
Rural	8 (1.5)	121 (13.6)	527 (31.3)
Socioeconomic characteristics	n (%)	n (%)	n (%)
Income inequality ratio1
Low (< 3.84)	26 (4.9)	226 (25.4)	773 (45.9)
Moderate (> 3.84 to < 6.71)	71 (13.3)	323 (36.3)	664 (39.4)
High (> 6.71)	438 (81.9)	341 (38.3)	246 (14.6)
Percent of county below poverty level
Low (< 11%)	295 (55.0)	292 (32.8)	452 (26.9)
Moderate (> 11% to < 15.2%)	163 (30.4)	307 (34.5)	577 (34.4)
High (> 15.2%)	78 (14.6)	291 (32.7)	654 (38.9)
Percent of county uninsured
Low (< 13.3%)	257 (47.9)	333 (37.4)	437 (26.0)
Moderate (> 13.3% to < 18.5%)	181 (33.8)	321 (36.1)	563 (33.4)
High (> 18.5%)	98 (18.3)	236 (25.5)	683 (40.6)
Physician characteristics (per 100000 women)	n (%)	n (%)	n (%)
Primary care physicians
0	1 (0.2)	15 (1.7)	115 (6.8)
Low (< 105.79)	120 (22.4)	347 (39.0)	515 (30.6)
Moderate (> 105.79 to 169.97)	182 (34.0)	327 (36.7)	505 (30.0)
High (> 169.97)	233 (43.5)	201 (22.6)	548 (32.6)
General surgeons
0	51 (9.5)	223 (25.1)	666 (39.6)
Low (< 11.72)	135 (25.2)	273 (30.7)	307 (18.2)
Moderate (> 11.72 to < 20.47)	138 (25.7)	249 (28.0)	352 (20.9)
High (> 20.47)	212 (39.6)	145 (16.3)	358 (21.3)
OB/GYNs
0	65 (12.1)	327 (37.7)	936 (55.6)
Low (< 11.27)	94 (17.5)	235 (26.4)	259 (15.4)
Moderate (> 11.27 to < 20.53)	139 (25.9)	199 (22.4)	268 (15.9)
High (> 20.53)	238 (44.4)	129 (14.5)	220 (13.1)
Population Characteristics	% (SE)	% (SE)	% (SE)
Non-Hispanic white	77.6 (17.7)	82.5 (16.9)	81.4 (20.1)
Non-Hispanic black	12.1 (14.1)	10.0 (14.8)	7.0 (14.6)
Non-Hispanic Asian/Pacific Islander	2.4 (3.5)	0.8 (1.3)	0.6 (0.8)
Non-Hispanic other2	1.6 (1.2)	2.0 (4.8)	3.2 (8.1)
Hispanic	6.3 (8.8)	4.7 (8.7)	7.7 (14.6)
Ages 0 to 44	60.8 (5.2)	58.0 (5.3)	55.7 (6.6)
Ages 45 to 54	14.7 (1.3)	14.4 (1.5)	14.4 (1.6)
Ages 55 to 64	10.5 (1.6)	11.3 (1.8)	11.5 (2.0)
Ages 65 to 74	6.8 (1.7)	7.9 (1.6)	8.7 (1.9)
Ages 75+	7.3 (2.2)	8.4 (2.3)	9.8 (3.1)

¹Defined as the ratio of the number of households with incomes above the population’s top 22% household income to the number of houses with incomes below the population’s bottom 22% household income;

²Includes Non-Hispanic American Indian/Alaska Native.

Table 2 Ovarian cancer incidence and mortality by distance to gynecologic oncologist practice location

	Distance to closest gynecologic oncologist
	0 to <25 miles	≥25 to < 50 miles	≥50 miles
Mortality
N	499	707	974
Rate (SE)	10.09 (3.14)	12.02 (4.73)	13.57 (6.43)
Incidence
N	519	855	1418
Rate (SE)	14.21 (4.23)	15.11 (6.54)	16.31 (8.51)

Table 3 Adjusted odds of high ovarian cancer mortality by gynecologic oncologist practice location

County level variable	Odds ratio	Odds ratio 95%CI	P-value
Distance to GO
≥ 25 to < 50 miles vs < 25 miles	1.40	(1.04, 1.89)	0.029
≥ 50 miles vs < 25 miles	1.59	(1.18, 2.15)	0.003
General surgeon per avg. pop.
1st Tertile: (< 11.72) vs 0	0.35	(0.24, 0.50)	< 0.001
2nd Tertile: (> 11.72 to < 20.47) vs 0	0.35	(0.24, 0.51)	< 0.001
3rd Tertile: (> 20.47) vs 0	0.32	(0.22, 0.48)	< 0.001
Incidence Rate	1.15	(1.12, 1.18)	< 0.001
% Population Age 45 to 54	1.25	(1.15, 1.37)	< 0.001
% Population Age 75+	1.39	(1.31, 1.48)	< 0.001
% Population non-Hispanic Asian/Pacific Islander	0.88	(0.80, 0.96)	0.004
% Population Hispanic	0.99	(0.97, 1.00)	0.027

The model is adjusted for all the covariates shown in the county level variable column. GO: Gynecologic oncologist.