J. Day1, W. E. Zahnd2, V. Poola1, J. Rakinic1, S. Ganai1,2 1Southern Illinois University School Of Medicine,Surgery,Springfield, IL, USA 2Southern Illinois University School Of Medicine,Population Science And Policy,Springfield, IL, USA
Introduction: Disparities in screening, incidence, and mortality for colorectal cancer (CRC) include race/ethnicity, geography, insurance, and other socioeconomic factors. Access disparities can cause treatment delays that impact outcomes. Shortages of gastroenterologists, surgeons, and radiation oncologists have been identified in rural areas. We hypothesized that disparities in spatial access to specialty-trained colorectal surgeons exist between rural and urban Illinois.
Methods: Data on colorectal surgeon location in Illinois and surrounding border locales were abstracted from the 2014 American Society of Colon and Rectal Surgeons directory with addresses geocoded. Data on population characteristics (age, education, median household income, and race/ethnicity) were obtained from the American Community Survey at the zip code tabulation area (ZCTA) level. Rurality was approximated using the University of Washington’s approximations of the United States Department of Agriculture’s Rural-Urban Commuting Area (RUCA) codes. Network Analyst tool in ARCGIS was used to calculate travel time. Independent t-test and ANOVA were performed to evaluate differences in travel time to the nearest colorectal surgeon by rurality. Choropleth maps were created to display travel time by ZCTA.
Results: Over half of individuals in isolated-rural (54.1%) and small rural (51.1%) locales in Illinois live more than 60 minutes away from a colorectal surgeon. For those who live in large rural areas, a large proportion (69.4%) live >30-minutes from a colorectal surgeon. In contrast, the majority who live in urban areas (88.8%) had <30 minutes travel time. Overall, mean travel time to a colorectal surgeon was 43.6±27.9 (SD) minutes. Mean travel time to the nearest colorectal surgeon was significantly greater from rural areas [60.30 ±24.40 minutes (SD)] compared to urban areas [29.10±22.29 minutes; p<0.001). Travel time to the nearest colorectal surgeon also differed across the 4-group RUCA rurality scale (p<0.001), with the greatest travel time for isolated (65.57±22.08 min) and small rural areas (66.88±24.97 min), and shorter travel time for large rural (47.24±19.28 min) and urban areas (29.10±22.29 min).
Conclusion: The rural population of Illinois experiences a greater burden of travel time for access to colorectal surgeons. The results support the hypothesis that a difference exists in access to colorectal cancer care in rural Illinois via geographic proximity to a colorectal surgeon. Further analysis including correlation to incidence and mortality and the role of complementary providers will be necessary to properly assess access to CRC care needs in Illinois.
