Journal of Applied Economic Research
ISSN 2712-7435
The Impact of the Supply of Oncologists on Mortality from Neoplasms in the Regions of Russia
Dmitry A. Subbotovsky, Viktor A. Kalashnikov, Alexander E. Drozd, Artur R. Nagapetyan
Far Eastern Federal University, Vladivostok, Russia
Abstract
How does one calculate the ideal number of oncologists for a region? The significance of this study is determined by the differences in these indicators observed across different regions within the Russian Federation. In 2021, the mortality rate from oncological diseases ranged from 54 to 270 per 100,000 people, with the lowest rate in the Republic of Ingushetia and the highest in the Tula Oblast. Furthermore, the level of oncologist availability varies up to fourfold between different regions. The study aims to simulate the effect of the availability of oncologist care on the cancer mortality rates in the Russian Federation's regions, with the intention of determining the ideal number of specialist doctors. The author supposes that there may be an underestimation of the negative impact of physicians on mortality rates due to false positive relationships between the variables under consideration. In addition, the author suggests that there may be diminishing returns from hiring additional physicians as the level of specialist personnel availability increases. The research project is designed to employ a regression analysis using the quasi-experimental instrumental variable method to address reverse causality and omitted variables. Models based on spatial sampling and panel data are employed to derive a function that describes the number of saved lives by means of hiring additional doctors. The results indicate that on average, a 1% increase in the availability of oncologists leads to a reduction in neoplasm mortality of at least 0.4%. At a provision level of 1 oncologist per 100,000 individuals, their marginal contribution to the number of saved lives is no less than 96 per 100,000 people. This contribution reduces by an additional 14 people as the provision level increases by 1 unit. The study's outcomes may assist in ascertaining the ideal quantity of oncologists within the region, and aid in allotting financial resources for hiring medical professionals in diverse specialties or other expenses amid resource constraints.
Keywords
oncology; instrumental variable method; mortality; neoplasms; optimal number of physicians.
JEL classification
I15, I18References
1. Cochrane, A.L., Leger, A.S.St., Moore, F. (1978). Health service 'Input' and mortality 'Output' in developed countries. Journal of Epidemiology & Community Health, Vol. 32, 200–205. http://dx.doi.org/10.1136/jech.32.3.200
2. Palmer, R.H., Reilly, M.C. (1979). Individual and institutional variables which may serve as indicators of quality of medical care. Medical Care, Vol. 17, Issue 7, 693–717. https://doi.org/10.1097/00005650-197907000-00001
3. Hopkins, Z.H., Moreno, C., Carlisle, R., Secrest, A.M. (2019). Melanoma prognosis in the United States: Identifying barriers for improved care. Journal of the American Academy of Dermatology, Vol. 80, Issue 5, 1256–1262. https://doi.org/10.1016/j.jaad.2019.01.003
4. Yiannakou, I., Barber, L.E., Li, S., Adams-Campbell, L.L., Palmer, J.R., Rosenberg, L., Petrick, J.L. (2022). A Prospective Analysis of Red and Processed Meat Intake in Relation to Colorectal Cancer in the Black Women's Health Study. The Journal of Nutrition, Vol. 152, Issue 5, 1254–1262. https://doi.org/10.1093/jn/nxab419
5. Vaccarella, S., Georges, D., Bray, F., et al. (2023). Socioeconomic inequalities in cancer mortality between and within countries in Europe: a population-based study. The Lancet Regional Health – Europe, Vol. 25, 100551. https://doi.org/10.1016/j.lanepe.2022.100551
6. Arnold, M., Rutherford, M.J., Bardot, A., et al. (2019). Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): A population-based study. The Lancet Oncology, Vol. 20, Issue 11, 1493–1505. https://doi.org/10.1016/S1470-2045(19)30456-5
7. Quaglia, A., Lillini, R., Mamo, C., Ivaldi, E., Vercelli, M. (2013). Socio-economic inequalities: a review of methodological issues and the relationships with cancer survival. Critical Reviews in Oncology/Hematology, Vol. 85, Issue 3, 266–277. https://doi.org/10.1016/j.critrevonc.2012.08.007
8. Afshar, N., English, D.R., Milne, R.L. (2019). Milne Rural-urban residence and cancer survival in high-income countries: A systematic review. Cancer, Vol. 125, Issue 13, 2172–2184. https://doi.org/10.1002/cncr.32073
9. Joshi, A., Wilson, L.E., Pinheiro, L.C., Judd, S., Akinyemiju, T. (2023). Association of racial residential segregation with all-cause and cancer-specific mortality in the reasons for geographic and racial differences in stroke (REGARDS) cohort study. SSM – Population Health, Vol. 22, 101374. https://doi.org/10.1016/j.ssmph.2023.101374
10. Rubino, C., Chiara, M., Abbruzzo, A., Ferrante, M. (2022). Socio-economic inequality, interregional mobility and mortality among cancer patients: A mediation analysis approach. Socio-Economic Planning Sciences, Vol. 82, 101247. https://doi.org/10.1016/j.seps.2022.101247
11. Ma, J., Zhu, Q., Han, S., Zhang, Y., Ou, W., Wang, H., Zhao, J., Liu, Z. (2012). Effect of socio-economic factors on delayed access to health care among Chinese cervical cancer patients with late rectal complications after radiotherapy. Gynecologic Oncology, Vol. 124, Issue 3, 395–398. https://doi.org/10.1016/j.ygyno.2011.11.040
12. Blakey, K., Feltbower, R.G., James, P.W., Libby, G., Stiller, C., Norman, P., Gerrand, C., McNally, R.J.Q. (2018). Socio-economic patterning in early mortality of patients aged 0–49 years diagnosed with primary bone cancer in Great Britain, 1985–2008. Cancer Epidemiology, Vol. 53, 49–55. https://doi.org/10.1016/j.canep.2018.01.012
13. Mederos, N., Friedlaender, A., Peters, S., Addeo, A. (2020). Gender-specific aspects of epidemiology, molecular genetics and outcome: lung cancer. Journal ESMO Open, Vol. 5, Issue 4, e000796. https://doi.org/10.1136/esmoopen-2020-000796
14. Siddiqui, F., Bae, K., Langer, C., Coyne, J., Gamerman, V., Komaki, R., Choy, H., Curran, W., Watkins-Bruner, D., Movsas, B. (2010). The Influence of Gender, Race, and Marital Status on Survival in Lung Cancer Patients: Analysis of Radiation Therapy Oncology Group Trials. Journal of Thoracic Oncology, Vol. 5, Issue 5, 631–639. https://doi.org/10.1097/JTO.0b013e3181d5e46a
15. Baum, P., Winter, H., Eichhorn, M.E., Roesch, R.M., Taber, S., Christopoulos, P., Wiegering, A., Lenzi, J. (2022). Trends in age- and sex-specific lung cancer mortality in Europe and Northern America: Analysis of vital registration data from the WHO Mortality Database between 2000 and 2017. European Journal of Cancer, Vol. 171, 269–279. https://doi.org/10.1016/j.ejca.2022.05.011
16. Karlsson, A., Ellonen, A., Irjala, H., et al. (2021). Impact of deep learning-determined smoking status on mortality of cancer patients: never too late to quit. Journal ESMO Open, Vol. 6, Issue 3, 100175. https://doi.org/10.1016/j.esmoop.2021.100175
17. García-Esquinas, E., Jiménez, A., Pastor-Barriuso, R., Jones, M.R., Perez-Gomez, B., Navas-Acien, A., Tellez-Plaza, M. (2018). Impact of declining exposure to secondhand tobacco smoke in public places to decreasing smoking-related cancer mortality in the US population. Environment International, Vol. 117, 260–267. https://doi.org/10.1016/j.envint.2018.05.008
18. Bjerkaas, E., Parajuli, R., Engeland, A., Maskarinec, G., Weiderpass, E., Gram, I.T. (2015). Social inequalities and smoking-associated breast cancer – Results from a prospective cohort study. Preventive Medicine, Vol. 73, 125–129. https://doi.org/10.1016/j.ypmed.2015.01.004
19. Elovainio, M., Lumme, S., Arffman, M., Manderbacka, K., Pukkala, E., Hakulinen, C. (2021). Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: A nationwide registry study. SSM – Population Health, Vol. 15, 100826. https://doi.org/10.1016/j.ssmph.2021.100826
20. Launders, N., Scolamiero, L., Osborn, D.P.J., Hayes, J.F. (2022). Cancer rates and mortality in people with severe mental illness: Further evidence of lack of parity. Schizophrenia Research, Vol. 246, 260–267. https://doi.org/10.1016/j.schres.2022.07.008
21. Ahlgrén-Rimpiläinen, A.J., Arffman, M., Suvisaari, J., Manderbacka, K., Lumme, S., Keskimäki, I., Huovinen, R., Pukkala, E. (2020). Excess mortality from breast cancer in female breast cancer patients with severe mental illness. Psychiatry Research, Vol. 286, 112801. https://doi.org/10.1016/j.psychres.2020.112801
22. Lin, Y., Liu, Q., Liu, F., et al. (2021). Adverse associations of sedentary behavior with cancer incidence and all-cause mortality: A prospective cohort study. Journal of Sport and Health Science, Vol. 10, Issue 5, 560–569. https://doi.org/10.1016/j.jshs.2021.04.002
23. Baraibar, I., Ros, J., Saoudi, N., Salvà, F., García, A., Castells, M.R., Tabernero, J., Élez, E. (2023). Sex and gender perspectives in colorectal cancer. Journal ESMO Open, Vol. 8, Issue 2, 101204. https://doi.org/10.1016/j.esmoop.2023.101204
24. Coleman, C.J., Yeager, R.A., Riggs, D.W., Coleman, N.C., Garcia, G.R., Bhatnagar, A., Pope, C.A. (2021). Greenness, air pollution, and mortality risk: A U.S. cohort study of cancer patients and survivors. Environment International, Vol. 157, 106797. https://doi.org/10.1016/j.envint.2021.106797
25. Rodriguez-Loureiro, L., Verdoodt, F., Lefebvre, W., Vanpoucke, C., Casas, L., Gadeyne, S. (2022). Long-term exposure to residential green spaces and site-specific cancer mortality in urban Belgium: A 13-year follow-up cohort study. Environment International, Vol. 170, 107571. https://doi.org/10.1016/j.envint.2022.107571
26. Cazzolla Gatti, R., Di Paola, A., Monaco, A., Velichevskaya, A., Amoroso, N., Bellotti, R. (2023). The spatial association between environmental pollution and long-term cancer mortality in Italy. Science of The Total Environment, Vol. 855, 158439. https://doi.org/10.1016/j.scitotenv.2022.158439
27. Song, I., Yoo, E.H., Jung, I., Oh, J.K., Kim, S.Y. (2023). Role of geographic characteristics in the spatial cluster detection of cancer: Evidence in South Korea, 1999–2013. Environmental Research, Vol. 236, 116841. https://doi.org/10.1016/j.envres.2023.116841
28. García-Pérez, J., Fernández-Navarro, P., Castelló, A., López-Cima, M.F., Ramis, R., Boldo, E., López-Abente, G. (2013). Cancer mortality in towns in the vicinity of incinerators and installations for the recovery or disposal of hazardous waste. Environment International, Vol. 51, 31–44. https://doi.org/10.1016/j.envint.2012.10.003
29. Hendryx, M., Conley, J., Fedorko, E., Luo, J., Armistead, M. (2012). Permitted water pollution discharges and population cancer and non-cancer mortality: toxicity weights and upstream discharge effects in US rural-urban areas. International Journal of Health Geographics, Vol. 11, 9. https://doi.org/10.1186/1476-072X-11-9
30. Xu, C., Xing, D., Wang, J., Xiao, G. (2019). The lag effect of water pollution on the mortality rate for esophageal cancer in a rapidly industrialized region in China. Environmental Science and Pollution Research, Vol. 26, 32852–32858. https://doi.org/10.1007/s11356-019-06408-z
31. Ayuso-Álvarez, A., García-Pérez, J., Triviño-Juárez, J.M., et al. (2020). Association between proximity to industrial chemical installations and cancer mortality in Spain. Environmental Pollution, Vol. 260, 113869. https://doi.org/10.1016/j.envpol.2019.113869
32. Nagapetyan, A., Drozd, A., Subbotovsky, D. (2023). How to determine the optimal number of cardiologists in the region? Mathematics, Vol. 11, Issue 21, 4422. https://doi.org/10.3390/math11214422
33. Simionescu, M., Bilan, S., Gavurova, B., Bordea, E.N. (2019). Health Policies in Romania to Reduce the Mortality Caused by Cardiovascular Diseases. International Journal of Environmental Research and Public Health, Vol. 16, 3080. https://doi.org/10.3390/ijerph16173080
34. Nagapetyan, A.R., Popov, M.A., Petrukhina, A.S. (2021). Spatial Autoregressive Analysis of the Tendency to Respiratory Diseases. The Bulletin of the Far Eastern Federal University. Economics and Management, Vol. 1, 5-14. (In Russ.). https://dx.doi.org/10.24866/2311-2271/2021-1/5-14
35. Nagapetyan, A.R., Petrukhina, A.S., Rymareva, A.A. (2023). Modeling of tuberculosis incidence rates in the regions of the Russian Federation based on a family of spatial autoregression models. Theory and Practice of Social Development, No. 1, 59–67. (In Russ.). https://doi.org/10.24158/tipor.2023.1.7
36. Sundmacher, L., Kopetsch, T. (2015). The impact of office-based care on hospitalizations for ambulatory care sensitive conditions. The European Journal of Health Economics, Vol. 16, Issue 4, 365–375. https://doi.org/10.1007/s10198-014-0578-4
37. Stewart, S.L, Cooney, D., Hirsch, S., Westervelt, L., Richards, T.B., Rim, S.H., Thomas, C.C. (2014). The Effect of Gynecologic Oncologist Availability on Ovarian Cancer Mortality. World Journal of Obstetrics and Gynecology, Vol. 3, Issue 2, 71–77. https://doi.org/10.5317/wjog.v3.i2.71
38. Hanna, T.P., King, W.D., Thibodeau, S., Jalink, M., Paulin, G.A., Harvey-Jones, E., O'Sullivan, D.E., Booth, C.M., Sullivan, R., Aggarwal, A. (2020). Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ, Vol. 371, m4087. https://doi.org/10.1136/bmj.m4087
39. Latimakha, R., Bahari, Z., Asmat, I. (2020). The relationship between the cost of living and the standard of living: factors determining the cost of living. Journal of Economics of Malaysia, Vol. 54, 1–14. https://doi.org/10.17576/JEM-2020-5403-01
Acknowledgements
The article was funded by the project “Spatial-autoregressive analysis of morbidity indicators for various classes of diseases in the regions of the Russian Federation”, as part of the implementation of the agreement on donation of funds, dated 19 May 2022, no. D-156-22 of the FEFU Endowment Fund to finance the winning projects from an open competition to support research and applied projects for the period from 7 February 2022 to 31 December 2024, from the FEFU School of Economics and Management, using income from the trust management of the target capital “FEFU Strategic Projects” (designated donation of the SBER (PJSC) for the development of SEM.
About Authors
Dmitry Andreyevich Subbotovsky
Manager, Laboratory of Data Analysis and Applied Econometric Research, Far Eastern Federal University, Vladivostok, Russia (690922, Primorsky Krai, Vladivostok, Russky Island, Ajax settlement, 10); ORCID https://orcid.org/0009-0001-1421-2157 e-mail: subbotovskii.da@students.dvfu.ru
Viktor Aleksandrovich Kalashnikov
Intern, Laboratory of Data Analysis and Applied Econometric Research, Far Eastern Federal University, Vladivostok, Russia (690922, Primorsky Krai, Vladivostok, Russky Island, Ajax settlement, 10); ORCID https://orcid.org/0009-0007-3038-1675 e-mail: kalashnikov.val@students.dvfu.ru
Alexander Evgenyevich Drozd
Post-Graduate Student, Assistant, Department of Applied Economics, School of Economics and Management, Far Eastern Federal University, Vladivostok, Russia (690922, Primorsky Krai, Vladivostok, Russky Island, Ajax settlement, 10); ORCID https://orcid.org/0009-0000-0001-6940-8491 e-mail: drozd.ae@dvfu.ru
Artur Rubikovich Nagapetyan
Candidate of Economic Sciences, Associate Professor, Department of Socio-Economic Research and Regional Development, School of Economics and Management, Head of the Laboratory of Data Analysis and Applied Econometric Research, Far Eastern Federal University, Vladivostok, Russia (690922, Primorsky Krai, Vladivostok, Russky Island, Ayaks settlement, 10); ORCID https://orcid.org/0000-0002-7885-2460 e-mail: nagapetyan_ar@dvfu.ru
For citation
Subbotovsky, D.A., Kalashnikov, V.A., Drozd, A.E., Nagapetyan, A.R. (2023). The Impact of the Supply of Oncologists on Mortality from Neoplasms in the Regions of Russia. Journal of Applied Economic Research, Vol. 22, No. 4, 892-931. https://doi.org/10.15826/vestnik.2023.22.4.036
Article info
Received September 13, 2023; Revised October 26, 2023; Accepted November 1, 2023.
DOI: https://doi.org/10.15826/vestnik.2023.22.4.036
Download full text article:
~799 KB, *.pdf
(Uploaded
13.12.2023)
Created / Updated: 2 September 2015 / 20 September 2021
© Federal State Autonomous Educational Institution of Higher Education «Ural Federal University named after the first President of Russia B.N.Yeltsin»
Remarks?
select the text and press:
Ctrl + Enter
Portal design: Artsofte
Contact us
Rector's Office
Rector, Dr. Victor Koksharov
Tel. +7 (343) 375-45-03, e-mail: rector@urfu.ru
Vice-Rector for International Relations, Dr. Maxim Khomyakov
Tel. +7 (343) 375-46-27, e-mail: Maksim.Khomyakov@urfu.ru