复杂医疗的区域差异被证明对健康结果产生负面影响。我们试图表征密歇根州食管癌手术的地理变异。分析了2000年至2013年密歇根癌症监测计划中局部食管癌患者的数据。我们回顾了按县和地区划分的食管癌发病率，并研究了接受食管切除手术的局部食管癌患者。县级数据按照现有的州级“城市 vs 农村”的划分方式进行了汇总，地区则按照密歇根经济复苏委员会的划分进行了汇总，并使用方差分析、F检验和卡方检验进行了数据分析。共有8,664名局部食管癌患者，其中2,370人（占27.4%）接受了手术治疗。男性接受食管切除术的可能性明显大于女性（p<0.001），白人大于非白人患者（p<0.001），有保险大于无保险患者（p=0.004），农村大于城市患者（p<0.001）。共有8个地区和83个县，其中61个被认为是农村，22个被认为是城市。地区1（底特律大都会区，东南部）拥有最大的城市和郊区人口以及4个重要医院系统，并被视为医疗保健获取的基准标准。与地区1相比，地区2（西部）（p=0.011）、3（西南部）（p=0.024）、4（东中部）（p=0.012）、6（下半岛北部）（p=0.008）和8（上半岛）（p<0.001）的年手术率之间都存在统计学上显著的更大差异。地区8的差异最大，是最为农村且距离地区1最远的地区。城乡之间的手术率差异显著（P=0.005）。与大型医院系统较远的区域以及农村县的护理差异显著增加。男性、白人、农村居住和有医疗保险的人更有可能接受手术治疗。版权所有 © 2023年美国外科医师学院。由 Wolters Kluwer Health, Inc. 发布。保留所有权利。

Regional variation in complex healthcare is shown to negatively impact health outcomes. We sought to characterize geographical variance in esophageal cancer surgery in Michigan.Data for patients with loco-regional esophageal cancer from the Michigan Cancer Surveillance Program from 2000-2013 was analyzed. We reviewed the incidence of esophageal cancer by county and region, and those with loco-regional disease receiving an esophagectomy. Counties were aggregated into existing state-level "urban vs rural" designations, regions were aggregated using the Michigan Economic Recovery Council designations, and data was analyzed with Anova, F-test, and chi-squared test.8,664 patients had loco-regional disease, with 2,370 (27.4%) treated with surgery. Men were significantly more likely to receive esophagectomy than women (p<0.001), White more than non-White patients (p<0.001), insured more than non-insured patients (p=0.004), and rural more than urban patients (p<0.001). There were 8 regions and 83 counties, with 61 considered rural, and 22 urban. Region 1 (Detroit metro area, Southeast) contains the largest urban and suburban population and 4 major hospital systems, and was considered the baseline standard for access to care. Regions 2 (West) (p=0.011), 3 (Southwest) (p=0.024), 4 (East Central) (p=0.012), 6 (Northern Lower Peninsula) (p=0.008), and 8 (Upper Peninsula) (p<0.001) all had a statistically significant greater variance in annual rates of surgery compared to Region 1. Region 8 had the largest variance and was the most rural and furthest from Region 1. The variance in surgery rate between urban and rural differed significantly (P = 0.005).A significant increase in variation of care was found in rural vs urban counties, as well as in regions distant to larger hospital systems. Those of male sex, White race, rural residence, and also having insurance were significantly more likely to receive surgery.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.