Association of Physician Densities and Gynecologic Cancer Outcomes in the United States

OBJECTIVETo evaluate whether there is an association between county-level obstetrician-gynecologist (ob-gyn) and primary care physician (PCP) densities and gynecologic cancer outcomes in the United States. METHODSA retrospective cohort study of gynecologic cancers (uterine, ovarian, and cervical) in the Surveillance, Epidemiology, and End Results (SEER) database was performed from 2005 to 2018. County-level demographics were abstracted from the SEER database, population density from the United States Census Bureau, and physician density (ob-gyns and PCPs/100,000 females) from the Area Health Resources File. Backward stepwise regression models were used. RESULTSFinal analysis included 113,938 patients for stage at diagnosis analysis and 98,573 patients for 5-year survival analysis. Uterine, ovarian, and cervical cancers represented 60.0%, 25.0%, and 15.0% of patients, respectively. Most counties (57%) were nonmetropolitan and had a mean ob-gyn density of 8 per 100,000 females and a mean PCP density of 89 per 100,000 females. Multivariate analysis showed that increasing PCP density was associated with earlier stage at diagnosis (95% CI -6.27 to -0.05; P