Association of primary care physician rate and cancer incidence and mortality rates in the US.

211 Background: Primary care physicians (PCPs) are crucial for cancer prevention, screening, and early detection. However, the association between PCP rate and cancer outcomes is underexplored. This ecological study assessed the association between county-level PCP rate and cancer incidence and mortality rates in the U.S. Methods: We used 2016 PCP rate (per 1,000 population) from Area Health Resources Files and age-adjusted cancer incidence (2017–2021) and mortality (2018–2022) rates from CDC State Cancer Profiles. Outcomes included all-stage and late-stage incidence and mortality for ten most common cancers. We used generalized linear mixed models, adjusting for urban–rural status, Social Vulnerability Index, hospital density, and state. Results: We included data from 3,143 counties, with PCP rate ranging from 0 to 4.77 per 1,000 population. Counties with lower PCP rate had more non-Hispanic Black residents and a population of older age, lower education, insurance coverage, and employment. Higher PCP rate was significantly associated with lower rates of late-stage cancer incidence for 9 of 10 cancer types except prostate cancer, with stronger associations for screenable cancers (Table). Each one-unit increase in PCP rate was associated with a reduced incidence (per 100,000 population) of late-stage colorectal (-4.48, 95% CI: -5.20, -3.76), lung (-7.45, 95% CI: -8.61, -6.30), cervical (-1.76, 95% CI: -2.18, -1.34) and breast cancer (-1.88, 95% CI: -3.04, -0.75). Similar patterns were observed for all-stage incidence. Higher PCP rate was also significantly associated with lower mortality for all 10 included cancer types, again with stronger associations for screenable cancers (Table). Conclusions: Higher PCP rate is associated with lower cancer incidence and mortality rates, particularly for cancers with established screening guidelines. Investing in strategies to bolster the primary care workforce and increase PCP access should be prioritized to enhance cancer care and reduce cancer burden. Adjusted association of primary care physician rate (per 1,000) and cancer incidence and mortality rates (per 100,000). Late-stage incidence All-stage incidence Mortality Lung and bronchus -7.45 (-8.61, -6.30) -10.17 (-11.67, -8.67) -8.36 (-9.40, -7.32) Colorectal -4.48 (-5.20, -3.76) -5.73 (-6.75, -4.72) -3.15 (-3.65, -2.66) Cervix -1.76 (-2.18, -1.34) -2.56 (-3.13, -1.99) -1.22 (-1.59, -0.87) Breast -1.88 (-3.04, -0.75) 5.49 (3.16, 7.83) -3.35 (-4.08, -2.64) Prostate 1.07 (0.16, 2.00) 5.74 (2.90, 8.57) -1.69 (-2.53, -0.85) Melanoma -0.93 (-1.18, -0.67) 1.79 (0.80, 2.77) -0.76 (-0.94, -0.58) Kidney and renal pelvis -1.37 (-1.65, -1.09) -3.72 (-4.31, -3.13) -1.09 (-1.31, -0.88) Bladder -0.62 (-0.80, -0.44) -1.78 (-2.33, -1.20) -1.13 (-1.36, -0.89) Leukemia - -0.97 (-1.44, -0.50) -1.20 (-1.50, -0.90) Non-Hodgkin Lymphoma -0.49 (-0.90, -0.09) -0.08 (-0.55, 0.39) -0.85 (-1.09, -0.61)