Dataset Information

Mortality and physician supply: does region hold the key to the paradox?

ABSTRACT:

Objective

. To determine if the supply of physicians has a consistent relationship with mortality across regions.

Data sources

County-level data describing the supply of physicians, mortality, and socioeconomic conditions of the population as provided in the Area Resource File (BHPr, HRSA) and the Compressed Mortality File (NCHS, CDC).

Study design

Ordinary least squares and geographically weighted regression models with age-adjusted all-cause and disease-specific mortality as the dependent variables were specified using pooled data from 1996 to 2000 to test for the relationship with primary care and specialist physician-population ratios. The residuals from the OLS models were mapped and examined for potential clustering. A series of geographically weighted regression models were run for all 3,070 counties and the z-scores and significance of the models mapped.

Principal findings

The association between primary care physician supply and mortality was not observed in contrast to other studies; mapping the residuals of those models suggested regional clustering. When weighted geographically, the relationship between primary care and specialist physician supply and mortality presents a mixed pattern. The results show strong regional patterns that may explain the lack of a consistent national association. Primary care physicians are associated with decreased mortality on the east coast and upper midwest, but that correlation disappears or is reversed in the west (with the exception of Washington State) and south central states.

Conclusions

We find evidence that there are regionally focused association between physician supply and mortality, holding constant population characteristics that reflect the influence of social and economic characteristics. However, these relationships are not consistent across the United States; there are regions where there are stronger and weaker associations between type of practitioner and mortality and other regions where no association is apparent. This suggests that the direction for further analysis lies in the understanding of the regional differences and whether there are policy alternatives to address these different patterns.

SUBMITTER: Ricketts TC

PROVIDER: S-EPMC2151400 | biostudies-literature | 2007 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Mortality and physician supply: does region hold the key to the paradox?

Ricketts Thomas C TC Holmes George M GM

Health services research 20071201 6 Pt 1

<h4>Objective</h4>. To determine if the supply of physicians has a consistent relationship with mortality across regions.<h4>Data sources</h4>County-level data describing the supply of physicians, mortality, and socioeconomic conditions of the population as provided in the Area Resource File (BHPr, HRSA) and the Compressed Mortality File (NCHS, CDC).<h4>Study design</h4>Ordinary least squares and geographically weighted regression models with age-adjusted all-cause and disease-specific mortality ...[more]

PMID: 17995563

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Project description:ImportanceRecent US health care reforms incentivize improved population health outcomes and primary care functions. It remains unclear how much improving primary care physician supply can improve population health, independent of other health care and socioeconomic factors.ObjectivesTo identify primary care physician supply changes across US counties from 2005-2015 and associations between such changes and population mortality.Design, setting, and participantsThis epidemiological study evaluated US population data and individual-level claims data linked to mortality from 2005 to 2015 against changes in primary care and specialist physician supply from 2005 to 2015. Data from 3142 US counties, 7144 primary care service areas, and 306 hospital referral regions were used to investigate the association of primary care physician supply with changes in life expectancy and cause-specific mortality after adjustment for health care, demographic, socioeconomic, and behavioral covariates. Analysis was performed from March to July 2018.Main outcomes and measuresAge-standardized life expectancy, cause-specific mortality, and restricted mean survival time.ResultsPrimary care physician supply increased from 196 014 physicians in 2005 to 204 419 in 2015. Owing to disproportionate losses of primary care physicians in some counties and population increases, the mean (SD) density of primary care physicians relative to population size decreased from 46.6 per 100 000 population (95% CI, 0.0-114.6 per 100 000 population) to 41.4 per 100 000 population (95% CI, 0.0-108.6 per 100 000 population), with greater losses in rural areas. In adjusted mixed-effects regressions, every 10 additional primary care physicians per 100 000 population was associated with a 51.5-day increase in life expectancy (95% CI, 29.5-73.5 days; 0.2% increase), whereas an increase in 10 specialist physicians per 100 000 population corresponded to a 19.2-day increase (95% CI, 7.0-31.3 days). A total of 10 additional primary care physicians per 100 000 population was associated with reduced cardiovascular, cancer, and respiratory mortality by 0.9% to 1.4%. Analyses at different geographic levels, using instrumental variable regressions, or at the individual level found similar benefits associated with primary care supply.Conclusions and relevanceGreater primary care physician supply was associated with lower mortality, but per capita supply decreased between 2005 and 2015. Programs to explicitly direct more resources to primary care physician supply may be important for population health.

Project description:BACKGROUND: The terrestrial habitat was colonized by the ancestors of modern land plants about 500 to 470 million years ago. Today it is widely accepted that land plants (embryophytes) evolved from streptophyte algae, also referred to as charophycean algae. The streptophyte algae are a paraphyletic group of green algae, ranging from unicellular flagellates to morphologically complex forms such as the stoneworts (Charales). For a better understanding of the evolution of land plants, it is of prime importance to identify the streptophyte algae that are the sister-group to the embryophytes. The Charales, the Coleochaetales or more recently the Zygnematales have been considered to be the sister group of the embryophytes However, despite many years of phylogenetic studies, this question has not been resolved and remains controversial. RESULTS: Here, we use a large data set of nuclear-encoded genes (129 proteins) from 40 green plant taxa (Viridiplantae) including 21 embryophytes and six streptophyte algae, representing all major streptophyte algal lineages, to investigate the phylogenetic relationships of streptophyte algae and embryophytes. Our phylogenetic analyses indicate that either the Zygnematales or a clade consisting of the Zygnematales and the Coleochaetales are the sister group to embryophytes. CONCLUSIONS: Our analyses support the notion that the Charales are not the closest living relatives of embryophytes. Instead, the Zygnematales or a clade consisting of Zygnematales and Coleochaetales are most likely the sister group of embryophytes. Although this result is in agreement with a previously published phylogenetic study of chloroplast genomes, additional data are needed to confirm this conclusion. A Zygnematales/embryophyte sister group relationship has important implications for early land plant evolution. If substantiated, it should allow us to address important questions regarding the primary adaptations of viridiplants during the conquest of land. Clearly, the biology of the Zygnematales will receive renewed interest in the future.

Dataset Information

Mortality and physician supply: does region hold the key to the paradox?

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Mortality and physician supply: does region hold the key to the paradox?

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